Surgical outcome of phaco-emulsification combined with trabeculectomy in 243 eyes

Comparison of long-term results of trabeculectomy and phacotrabeculectomy in patients with pseudoexfoliation glaucoma and primary open-angle glaucoma: a single-center study

PURPOSE

To evaluate long-term surgical success and complications in pseudoexfoliation glaucoma (PEXG) and primary open-angle glaucoma (POAG) after trabeculectomy or phacotrabeculectomy.

METHODS

96 PEXG eyes and 114 POAG eyes who underwent primary trabeculectomy and phacotrabeculectomy were retrospectively evaluated considering intraocular pressure (IOP), the number of glaucoma medications, surgical success, and rate of complications. Two success criteria were used: Complete success comprised IOP of 5-18 mmHg and 20% reduction of baseline IOP without medication. Qualified success comprised IOP of 5-18 mmHg and 20% reduction of baseline IOP irrespective of medication. Success rates in PEXG and POAG groups, trabeculectomy and phacotrabeculectomy groups, and four groups divided according to surgery and etiology were analyzed via Kaplan-Meier survival analysis.

RESULTS

The complete and qualified success were not different between PEXG and POAG groups. The qualified success curves show a similar pattern among the four groups throughout the follow-up of 1,2,3,5,7 and 9 years. Baseline IOP and the number of medications were similar in all four groups (p = 0.275 and p = 0.209, respectively). IOP levels and the number of medications were not statistically different between the four groups during the follow-up of 2,5 and 7 years. The total number of complications and interventions were similar between PEXG and POAG groups (p = 0.258).

CONCLUSIONS

Phacotrabeculectomy is an effective procedure as trabeculectomy with similar surgical success rates and few surgical complications when it comes to treating PAOG and PEXG patients. Both approaches resulted in similar postoperative IOP levels and medication numbers in both groups.

Combined Viscocanalostomy and Cataract Surgery Compared with Cataract Surgery in Japanese Patients with Glaucoma

PURPOSE

To compare intraocular pressure (IOP) and the incidence of complications after combined viscocanalostomy and cataract surgery with cataract surgery alone in 206 Japanese eyes with POAG or OH.

PATIENTS AND METHODS

In a nonrandomized comparative, clinical study, 103 eyes underwent viscocanalostomy and cataract surgery (VCS group), and 103 eyes underwent cataract surgery alone (CSA group) (follow-up, 6-24 months). Reductions in IOP and medications, the probability of successful IOP reduction visual acuity changes, and complications were compared between the 2 groups.

RESULTS

The reductions in IOP and number of medications in the VCS group were significantly greater than in the CSA group (P < or = 0.0038 and P < or = 0.0259, respectively). The probabilities of achieving IOPs less than 21, 18, and 15 mm Hg at 24 months in the VCS groups were 85.0%, 53.6%, and 17.2% with medications, and 61.1%, 43.9%, and 16.2% without medications, and significantly better than in the CSA group (P < 0.0002). The visual outcomes were similar in both groups. Postoperative complications such as hyphema and fibrin formation, although more frequent in the VCS group, were not vision threatening.

CONCLUSION

Combined viscocanalostomy and cataract surgery provides good postoperative visual acuity with minimal complications and significantly greater IOP reduction than cataract surgery alone for Japanese patients with glaucoma.

Comparison of outcomes of viscocanalostomy and phacoviscocanalostomy

BACKGROUND

Many adults who undergo glaucoma filtering surgery also need surgical treatment of coexisting cataract. Recent reports of the use of new alternative non-penetrating techniques in combination with phacoemulsification have given encouraging results. The purpose of this study was to compare the safety and efficacy of viscocanalostomy and phacoviscocanalostomy in the management of medically uncontrolled open-angle glaucoma.

METHODS

Twenty patients who underwent phacoviscocanalostomy in one eye each were enrolled in the study. Twenty matching patients who underwent viscocanalostomy in one eye each at our institution were selected as the control group. Postoperative reductions in intraocular pressure (IOP) and number of antiglaucoma medications were compared between the groups. Visual acuity and complications were secondary outcomes.

RESULTS

Significant reductions of IOP and of use of antiglaucoma medication occurred in both groups (p < 0.05); these results were comparable in the two groups (p > 0.05). The mean IOP reduction was 34% in the eyes that underwent viscocanalostomy alone and 38% in the eyes that underwent phacoviscocanalostomy. The success rates of the two procedures were also comparable (p > 0.05). In the combined-surgery group the best-corrected visual acuity improved by 2 or more lines in 18 eyes (90%). Intraoperative complications did not occur in either group.

INTERPRETATION

Combining phacoemulsification with viscocanalostomy did not have a negative effect on the IOP control achieved by viscocanalostomy alone and did not increase the complication rate. Phacoviscocanalostomy was safe and effective in the surgical management of eyes with both glaucoma and cataract.

Comparison between phacoemulsification and the Blumenthal technique of manual small-incision cataract surgery combined with trabeculectomy

OBJECTIVE

To compare results of filtration combined with either phacoemulsification or the Blumenthal technique of manual small-incision cataract surgery.

MATERIALS AND METHODS

Records of glaucoma "triple" operations from March 1997 to May 2000 were reviewed. Seventy-eight eyes (70 patients) that underwent phaco-triple were compared with 86 eyes (80 patients) that underwent the Blumenthal technique of manual small-incision cataract surgery combined with filtration (Blumenthal triple). Three minutes of 0.4 mgs/ml Mitomycin was used in all eyes. Posterior chamber IOLs were implanted through 5.5-mm incisions in both groups. Outcome measures were intraocular pressure (IOP) reduction and achievement of target IOP. Fourteen patients who underwent phacoemulsification-triple in one eye and Blumenthal triple in the other eye were also evaluated separately.

RESULTS

The minimum follow-up period was 6 months (range 6-30 months). At last follow-up review, mean reduction in IOP was 17.7 mm Hg (+/- 9.3 mm Hg) in the phaco group and 17.1 mm Hg (+/- 10 mm Hg) in the Blumenthal group. At last visit, target IOP was achieved in 75.6% of the phaco group and 73% of the Blumenthal group. There was no significant difference between groups in IOP reduction or achievement of target IOP. In the 14 patients who had undergone phaco-triple in one eye and Blumenthal-triple in the other, there was no inter-eye difference in IOP reduction.

CONCLUSIONS

In this small retrospective study we could not demonstrate a difference in IOP outcomes between the two procedures.

Long term effect on intraocular pressure of phacotrabeculectomy compared to trabeculectomy

AIM

To compare the long term mean intraocular pressure (IOP) reduction after non-augmented single site phacotrabeculectomy with that after trabeculectomy and to determine the relation between preoperative IOP and IOP reduction.

METHODS

A group of 44 consecutive patients with chronic open angle glaucoma who underwent phacotrabeculectomy were matched to a trabeculectomy control group and the results of surgery were compared. Linear regression analysis of preoperative IOP and IOP reduction was undertaken.

RESULTS

The mean IOP reduction was significantly less in the phacotrabeculectomy group (6.7 (SD 2.1) mm Hg) than in the trabeculectomy group (11.0 (1.4) mm Hg) (p=0.0017). There was a significant difference in surgical success between the groups. The preoperative IOP was significantly related to the postoperative reduction in IOP in both groups (p<0.001).

CONCLUSIONS

In elderly white patients with chronic open angle glaucoma, phacotrabeculectomy is not as effective as trabeculectomy in reducing IOP. In both procedures the magnitude of IOP reduction is proportional to the preoperative IOP.

Combined surgery in the treatment of patients with cataract and primary open-angle glaucoma

The literature on combined surgery in the treatment of patients with cataract and primary open-angle glaucoma was comprehensively studied, and all aspects and variations of the combined procedure were assessed. Phacoemulsification has improved the success rate and reduced the complication rate previously associated with extracapsular cataract extraction combined with trabeculectomy. A mean reduction in intraocular pressure (IOP) of 5 to 8 mm Hg can be achieved. One- and 2-site techniques appear to be similarly effective. Phacotrabeculectomy augmented with mitomycin-C achieves a lower IOP than phacotrabeculectomy alone but has a higher complication rate. The use of 5-fluorouracil is not as effective as mitomycin-C and has a variable influence on the results. The development of new techniques that combine nonpenetrating glaucoma surgery with phacoemulsification offers interesting surgical alternatives, but no long-term results have been reported.

Combined cataract and glaucoma surgery

The management of cataract in glaucoma patients has been continuously changing over the past decade. Extracapsular cataract extraction has been replaced by small-incision phacoemulsification with foldable lenses, and in glaucoma surgery, adjunctive antifibrotic therapy based on risk factors for failure has become standard. Furthermore, new techniques in filtering and nonfiltering surgery have been suggested. The techniques, however, change so fast that well-controlled studies with a follow-up of more than 12 months are increasingly seldom. The purpose of this paper is to review the current literature and to point out some new ideas for the future investigation.