The Effects of Trabeculectomy on Ocular Pulse Amplitude in Patients with Glaucoma

Objectives: This study aimed to investigate whether trabeculectomy and its intraocular pressure (IOP)-lowering effect have an effect on ocular pulse amplitude (OPA) in glaucoma patients. Methods: Thirty-five consecutive patients with glaucoma (70 eyes) who had undergone unilateral first-time trabeculectomy between April and November 2012 were enrolled in this retrospective study. Patients with intraoperative or postoperative complications were excluded from this study. The eye that underwent trabeculectomy was considered the study eye; the fellow eye was used as the control eye. OPA and IOP were measured by Pascal dynamic contour tonometry (DCT), IOP was measured by Goldmann applanation tonometry (GAT), and systolic and diastolic blood pressure and heart rate were measured before and one month after trabeculectomy. The change in the pre- and postoperative values was compared between the two eyes. Results: The study sample included 17 male and 18 female patients with a mean age of 60.83±13.46 years. The mean preoperative GAT, DCT and OPA values in the study eyes were 24.97±8.26, 31.23±10.55 and 4.22±1.77 mmHg, respectively. One month after trabeculectomy, the GAT, DCT and OPA values were 12.83±4.35, 20.28±7.34 and 2.96±1.66 mmHg, respectively. There was a significant decrease in OPA after filtration surgery in the study eyes (p0.05). Changes in OPA were positively correlated with changes in IOP (p


1. Quigley HA. Number of people with glaucoma worldwide. Br J Ophthalmol 1996;80:389–93.

2. Goldmann H, Schmidt T. [Applanation tonometry]. [Article in German]. Ophthalmologica 1957;134:221–42.

3. Shields MB. Normal-tension glaucoma: Is it different from primary open-angle glaucoma? Curr Opin Ophthalmol 2008;19:85–8.

4. Nakagami T, Yamazaki Y, Hayamizu F. Prognostic factors for progression of visual field damage in patients with normal-tension glaucoma. Jpn J Ophthalmol 2006;50:38–43.

5. Comparison of glaucomatous progression between untreated patients with normal-tension glaucoma and patients with therapeutically reduced intraocular pressures. Collaborative Normal-Tension Glaucoma Study Group. Am J Ophthalmol 1998;126 :487–97.

6. Heijl A, Leske MC, Bengtsson B, Hyman L, Bengtsson B, Hussein M; Early Manifest Glaucoma Trial Group. Reduction of intraocular pressure and glaucoma progression: results from the early manifest glaucoma trial. Arch Ophthalmol. 2002;120:1268–79.

7. Kass MA, Heuer DK, Higginbotham EJ, Johnson CA, Keltner JL, Miller JP, et al. The ocular hypertension treatment study: A randomized trial determines that topical ocular hypotensive medication delays or prevents the onset of primary open-angle glaucoma. Arch Ophthalmol 2002;120:701–13; discussion 829–30.

8. Netland PA. Nonpenetrating glaucoma surgery. Ophthalmology 2001;108:416–21.

9. Cairns JE. Trabeculectomy preliminary report of a new method. Am J Ophthalmol 1968;66:673–9.

10. Razeghinejad MR, Fudemberg SJ, Spaeth GL. The changing conceptual basis of trabeculectomy: a review of past and current surgical techniques. Surv Ophthalmol 2012;57:1–25.

11. Hitchings R. The ocular pulse. Br J Ophthalmol 1991;75:65.

12. James CB. Pulsatile ocular blood flow. Br J Ophthalmol 1998;82:720–1.

13. Langham ME, Farrell RA, O'Brien V, Silver DM, Schilder P. Blood flow in the human eye. Acta Ophthalmol Suppl 1989;191:9–13.

14. Choi J, Lee J, Park SB, Lee KS, Sung KR, Kook MS. Factors affecting ocular pulse amplitude in eyes with open angle glaucoma and glaucoma-suspect eyes. Acta Ophthalmol 2012;90:552–8.

15. Wang J, Cayer MM, Descovich D, Kamdeu-Fansi A, Harasymowycz PJ, Li G, et al. Assessment of factors affecting the difference in intraocular pressure measurements between dynamic contour tonometry and Goldmann applanation tonometry. J Glaucoma 2011;20:482–7.

16. Özçetin H, Baykara M, Atasoy A, Atasoy DT, Aslancı ME, Günerigök MS. Importance of Dynamic Contour Tonometry to Evaluate the Ocular Pulse Amplitude. Glo-Kat 2008;3:153– 7.

17. Çağlar Ç, Karpuzoğlu N, Batur M, Ceyhan D, Yaşar T. Comparison of Goldmann Applanation Tonometry, Pascal Dynamic Contour Tonometry and Tonopen in Eyes with High Intraocular Pressure and Effect of Central Corneal Thickness on Measurement Results. Glo-Kat 2012;7:84–90.

18. Kniestedt C, Kanngiesser HE. [Dynamic contour tonometry]. [Article in German]. Der Ophthalmologe 2006;103:713–22.

19. Christophe B, Steffen F, Thierry Z, Ingeborg S. The Effect of Trabeculectomy on Ocular Pulse Amplitude. Investigative Ophthalmology & Visual Science 2010;51:231–5.

20. von Schulthess SR, Kaufmann C, Bachmann LM, Yanar A, Thiel MA. Ocular pulse amplitude after trabeculectomy. Graefes Arch Clin Exp Ophthalmol 2006;244:46–51

21. Kaufmann C, Bachmann LM, Thiel MA. Comparison of dynamic contour tonometry with Goldmann applanation tonometry. Invest Ophthalmol Vis Sci 2004;45:3118–21.

22. Galassi F, Sodi A, Ucci F, Renieri G, Pieri B, Baccini M. Ocular hemodynamics and glaucoma prognosis: A color doppler imaging study. Arch Ophthalmol 2003;121:1711–5.

23. Schmidt KG, von Rückmann A, Pillunat LE. Topical carbonic anhydrase inhibition increases ocular pulse amplitude in high tension primary open angle glaucoma. Br J Ophthalmol 1998;82:758–62.

24. Berisha F, Schmetterer K, Vass C, Dallinger S, Rainer G, Findl O, et al. Effect of trabeculectomy on ocular blood flow. Br J Ophthalmol 2005;89:185–8.

25. Schulzer M, Drance SM. Intraocular pressure, systemic blood pressure, and age: A correlational study. Br J Ophthalmol 1987;71:245–9.

Kaynak Göster