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Singh K, Wali K, Singh A, Bhattacharyya M, Dangda S. Impact of Phacoemulsification on Trabeculectomy Bleb Function and Morphology in Primary Angle Closure Glaucoma: A Comparative Study of the Visco-Cushion Effect. Cureus 2024; 16:e70749. [PMID: 39493027 PMCID: PMC11531063 DOI: 10.7759/cureus.70749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2024] [Accepted: 10/03/2024] [Indexed: 11/05/2024] Open
Abstract
Purpose This study evaluates the impact of phacoemulsification on trabeculectomy bleb morphology and intraocular pressure (IOP) control in patients with primary angle closure glaucoma (PACG). The study also evaluates possible alterations in these effects by intra-operative blocking of internal sclerostomy by high-density viscoelastic (visco-cushion). Methods This is a single-center, interventional, prospective study including patients with PACG who underwent phacoemulsification post-trabeculectomy. This study also evaluated the effect of sodium hyaluronate 1.4% as a cushion to block the sclerostomy site. Patients were divided into two groups: group A received this intervention, while group B did not. Postoperative IOP and the number of glaucoma medications at week 2, month 1, and month 4 were assessed as a measure of bleb function. Bleb morphology was analyzed at these timepoints using the Indiana Bleb Appearance Grading Scale (IBAGS) and anterior segment optical coherence tomography (AS-OCT). Results The study included 35 patients with a mean age of 59.91 ± 7.59 years. The mean interval between trabeculectomy and phacoemulsification was 6.83 ± 5.57 years (range: 1-20 years). Mean preoperative IOP was 15.43 ± 2.62 mm Hg, with 12 eyes needing anti-glaucoma medications (AGMs). Mean IOP at postoperative month 4 was 12.69 ± 2.32 mm Hg (p<0.001, chi-square test), with one eye needing AGM. IOP reduction was significantly lower in the visco-cushion group (p<0.05, ANOVA test). By the end of four months, 97.14% of patients showed complete success as compared with 65% preoperatively. Bleb morphology was noted to be maintained in up to 66% patients in terms of bleb height and extent on IBAGS, as well as bleb internal reflectivity and the number of microcysts, as noted on AS-OCT. The group without a visco-cushion exhibited a significant decrease in qualitative bleb height and microcystic spaces, along with an increase in bleb vascularity (p<0.05, Fischer exact test). Thirty patients (87.5%) showed a >20% decline in bleb height on AS-OCT, which was greater in group without visco-cushion (p<0.05, Mann-Whitney U test). Conclusion Use of a visco-cushion during phacoemulsification in PACG eyes with prior functioning trabeculectomy resulted in the retention of healthy bleb morphology parameters except bleb wall thickening. However, this protective effect on bleb morphology did not transcribe into IOP reduction. On the contrary, conventional phacoemulsification despite bleb height reduction, increased bleb vascularity, and decreased microcystic spaces resulted in better IOP control in the first four months after surgery. Longer follow-up of these cases is suggested to examine eventual fate of these bleb morphological alternations.
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Affiliation(s)
- Kirti Singh
- Ophthalmology, Guru Nanak Eye Centre, Delhi, IND
| | - Keerti Wali
- Ophthalmology, Shri B. M. Patil Medical College, Bijapur Lingayat Development Education (BLDE) (Deemed to be University), Vijayapura, IND
| | - Arshi Singh
- Ophthalmology, Guru Nanak Eye Centre, Delhi, IND
| | | | - Sonal Dangda
- Ophthalmology, Atrium Health Wake Forest Baptist, Winston-Salem, USA
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Femtosecond Laser-assisted Cataract Surgery in Patients With Prior Glaucoma Surgery. J Glaucoma 2022; 31:547-556. [PMID: 35763680 DOI: 10.1097/ijg.0000000000002034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 03/29/2022] [Indexed: 11/25/2022]
Abstract
PRCIS Femtosecond laser-assisted cataract surgery (FLACS) is a safe procedure in glaucomatous eyes with prior glaucoma surgery, evidenced by stable intraocular pressure (IOP) and medication use, acceptable success rate, disease stability, and low complication rates at 1-year postoperative. PURPOSE The purpose of this study was to assess the 1-year efficacy and safety of FLACS in glaucomatous eyes with prior glaucoma surgery. MATERIALS AND METHODS Retrospective case series of all consecutive glaucomatous eyes with previous glaucoma surgery that underwent FLACS using the Catalys Precision Laser System with or without concomitant glaucoma surgery at a single ophthalmology center, between 2014 and 2020. Efficacy included change in IOP, glaucoma medication use, best-corrected visual acuity, and surgical success at 12 months postoperatively (POM12). Safety included structural and functional measures of disease stability and postoperative adverse events. RESULTS A total of 57 eyes with an average age of 62.6±8.1 years were included. At POM12, IOP decreased from 14.5±6.6 mmHg to 13.5±3.7 mm Hg (P=0.22) and glaucoma medication use decreased from 2.1±1.5 to 1.8±1.4 with a marginal significance (P=0.089). Best-corrected visual acuity improved significantly in both groups (P<0.001) and surgical success ranged between 74% and 90% according to the study's success criteria. Safety was favorable with disease stability evidenced by lack of deterioration in cup-to-disc ratio, visual field mean deviation, retinal nerve fiber layer thickness, and ganglion cell-inner plexiform layer thickness. One eye with prior history of trabeculectomy experienced transient bleb leak. Other adverse events were minor without sight-threatening sequelae. CONCLUSIONS The results of this study suggest that FLACS with or without concomitant glaucoma surgery could be a safe procedure in glaucomatous eyes-a population for which FLACS has been relatively contraindicated. Nonetheless, in those with preexisting filtering bleb, extra attention should be paid to the bleb area.
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Abstract
PURPOSE OF REVIEW To review the current literature on the relationship between cataract extraction and intraocular pressure (IOP). RECENT FINDINGS Cataract extraction can be an effective IOP lowering treatment for open and closed angle glaucoma as well as ocular hypertension. In comparative trials studying novel micro-invasive glaucoma surgeries in open angle glaucoma, the control group undergoing cataract extraction alone routinely achieved significant reductions in IOP and medication use postoperatively. Data from the Effectiveness in Angle Closure Glaucoma of Lens Extraction (EAGLE) trials have demonstrated that lens extraction is more effective at lowering IOP than peripheral iridotomy in patients with angle closure and should be considered as first line therapy. Additionally, patients in the ocular hypertension treatment study who underwent cataract extraction over the course of follow-up demonstrated significant IOP lowering sustained over 3 years. SUMMARY Cataract extraction is an effective method to lower IOP in patients with glaucoma. Pressure lowering is more significant in eyes with narrow angles and those with higher baseline IOP levels. In eyes with angle closure, phacoemulsification alone can lower IOP, but when combined with GSL it may be even more effective. Recent large multicenter randomized trials have further elucidated the benefit of standalone cataract extraction to treat mild to moderate primary open angle glaucoma. Prospective and longitudinal studies that systematically investigate the variables that may influence degree and duration of IOP lowering post cataract extraction are lacking.
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Nassiri N, Nassiri N, Mohammadi B, Rahmani L. Comparison of 2 Surgical Techniques in Phacotrabeculectomy: 1 Site versus 2 Sites. Eur J Ophthalmol 2018; 20:316-26. [DOI: 10.1177/112067211002000210] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nader Nassiri
- Department of Ophthalmology, Imam Hossein Medical Center, Shaheed Beheshti University of Medical Sciences, Tehran
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Anbar M, Ammar H. Effect of different incision sites of phacoemulsification on trabeculectomy bleb function: prospective case-control study. BMC Ophthalmol 2017. [PMID: 28651590 PMCID: PMC5485683 DOI: 10.1186/s12886-017-0500-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background The aim of this study was to compare superior and temporal clear corneal incisions of uneventful phacoemulsification and in-the-bag intraocular lens implantation on intraocular pressure control and the bleb morphology in eyes that have undergone previous successful trabeculectomy. Methods In this Prospective case-control study, a total of 100 eyes of 100 patients previously undergone trabeculectomy without antimetabolites, divided into two groups. Group A (temporal group) including 50 patients underwent phacoemulsification with a temporal corneal incision and group B (superior group) including 50 patients underwent phacoemulsification with a superior corneal incision. Comparisons between the two groups were performed after one year of follow-up regarding Intraocular pressure changes, bleb morphology score using the Wuerzburg bleb classification score and any added glaucoma medications. Results At the last visit, the mean intraocular pressure for the temporal group was 17.55 ± 1.47 (p = 0.51) and for the superior group was 16.90 ± 1.71 (p = 0.85); the difference between the two groups was insignificant (p = 0.21). Regarding the bleb morphology, the mean bleb morphology score in the temporal group was 10.50 ± 0.95 (p = 0.19) and for the superior group was 10.20 ± 1.06 (p = 0.01).There was an insignificant difference in the bleb grading morphology regarding both groups (p = 0.35). Conclusion Our study demonstrates that phacoemulsification whether done with a clear temporal or clear superior wound, does not affect intraocular pressure, bleb morphology or function after one year of follow-up in eyes following previous successful trabeculectomy. Furthermore, cataract surgery may be performed safely in eyes with functioning filtering blebs. Trial registration ISRCTN91835217 ‘retrospectively registered’ Date Of registration 6/6/2017
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Affiliation(s)
- Mohamed Anbar
- Sohag University, Faculty of Medicine, Sohag, Egypt. .,Ophthalmology Department, Sohag University Hospital, Sohag, 82511, Egypt.
| | - Hatem Ammar
- Sohag University, Faculty of Medicine, Sohag, Egypt
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Yassin SA. Bleb-related infection revisited: a literature review. Acta Ophthalmol 2016; 94:122-34. [PMID: 26249675 DOI: 10.1111/aos.12805] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 06/15/2015] [Indexed: 11/28/2022]
Abstract
Bleb-related infection (BRI) is one of the serious complications of glaucoma filtering surgery. This literature review is aimed at the evaluation of recent studies related to BRI. The review presented and discussed risk factors, and clinical and laboratory diagnosis emphasizing advances in diagnostic techniques to detect and distinguish the disease as well as to initiate immediate intensive antibacterial treatment. Clinical features of recognized prognostic factors of visual outcome were also presented. The studies showed that the prognosis of blebitis is usually good, unless infection has progressed to endophthalmitis that would signify a poorer prognosis. Despite prompt and intensive treatment of patients with bleb-related endophthalmitis, the outcomes remain unsatisfactory especially with virulent organisms and low initial visual acuity. It has been recommended that early detection and treatment of risk factors and thorough patient education are indispensable in ensuring best prognosis in post-trabeculectomy patients.
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Affiliation(s)
- Sanaa A. Yassin
- Department of Ophthalmology; University of Dammam; Dammam Saudi Arabia
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Efficacy and safety of intracameral triamcinolone acetonide to control postoperative inflammation after phacotrabeculectomy. J Cataract Refract Surg 2013; 39:1691-7. [DOI: 10.1016/j.jcrs.2013.04.042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 04/21/2013] [Accepted: 04/29/2013] [Indexed: 11/18/2022]
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Dada T, Bhartiya S, Begum Baig N. Cataract Surgery in Eyes with Previous Glaucoma Surgery: Pearls and Pitfalls. J Curr Glaucoma Pract 2013; 7:99-105. [PMID: 26997791 PMCID: PMC4741148 DOI: 10.5005/jp-journals-10008-1145] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Accepted: 04/28/2013] [Indexed: 11/23/2022] Open
Abstract
The problem of cataract management in the patients of glaucoma who have undergone fltering surgery is a challenging proposition for any surgeon, as the surgery can lead to several complications in the already compromised eye. As glaucoma requires lifelong management, the development of cataract is a significant concern because its treatment may lead to loss of intraocular pressure (IOP) control. This review aims to highlight the intra- and postoperative measures that may increase the chances of bleb survival following cataract surgery. How to cite this article: Dada T, Bhartiya S, Baig NB. Cataract Surgery in Eyes with Previous Glaucoma Surgery: Pearls and Pitfalls. J Current Glau Prac 2013;7(3):99-105.
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Affiliation(s)
- Tanuj Dada
- Professor, Department of Ophthalmology, Dr RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Shibal Bhartiya
- Consultant, Department of Ophthalmology, Glaucoma Services, Fortis Memorial Research Institute, Gurgaon, Haryana, India
| | - Nafees Begum Baig
- Associate Consultant, Department of Ophthalmology, Hong Kong Eye Hospital Chinese University of Hong Kong, Hong Kong
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Sałaga-Pylak M, Kowal M, Zarnowski T. Deterioration of filtering bleb morphology and function after phacoemulsification. BMC Ophthalmol 2013; 13:17. [PMID: 23617885 PMCID: PMC3638009 DOI: 10.1186/1471-2415-13-17] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 04/17/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Trabeculectomy remains the most efficient method of lowering he IOP applied for the treatment of glaucoma refractory to pharmacological treatment. Cataract is concerned as the most frequent late complication of trabeculectomy. The aim of the study was to analyse the effect of phacoemulsification with posterior chamber lens implantation on the morphology and function of filtering bleb in patients after previous successful trabeculectomy. METHODS The retrospective study included 122 eyes treated for primary open angle glaucoma, 50 eyes (study group) in which, after a successful trabeculectomy with 5-Fluorouracil, phacoemulsification with posterior chamber lens implantation was performed, and 72 eyes (control group), in which only a successful trabeculectomy was conducted. The surgical success of the trabeculectomy was expressed as IOP < 17 mmHg. RESULTS In the group of patients subjected to both trabeculectomy and phacoemulsification, mean IOP was significantly higher than in the group of patients who underwent trabeculectomy after 6 months (p = 0.003), 12 months (p = 0.01) and 18 months (p = 0.007) of observation. The filtering blebs after phacoemulsification in the study group were characterized by a greater reduction, compared to those in the control group. Cox regression survival success was 75% (SE = 5.9; 95% CI: 63.4-86.6), 75% (SE = 5.9; 95% CI: 63.4-86.6), 71% (SE = 5.4; 95% CI: 60.4-81.6) in study group and 92% (SE = 1.8; 95% CI: 91.5-98.5), 92% (SE = 1.9; 95% CI: 88.3-95.7), 91% (SE = 2.0; 95% CI: 87.1-94.9) in control group after 6, 12 and 18 months, respectively. CONCLUSIONS Phacoemulsification causes a significant elevation of IOP in the eyes after previous successful trabeculectomy and deterioration of filtering bleb morphology.
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Affiliation(s)
- Monika Sałaga-Pylak
- Chair of Ophthalmology, Medical University of Lublin, Chmielna Str No 1, 20-079 Lublin, Poland
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Peponis VG, Chalkiadakis SE, Katzakis MC, Parikakis EA. The effect of phacoemulsification on late bleb failure or intraocular pressure in patients with glaucoma: a systematic review. Clin Ophthalmol 2012; 6:1045-9. [PMID: 22848146 PMCID: PMC3402125 DOI: 10.2147/opth.s32875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The purpose of our systematic review is to document the adverse events that follow phacoemulsification in eyes with trabeculectomy due to glaucoma and to determine whether phacoemulsification jeopardizes the survival of the trabeculectomy. Our research was based on English- and non-English-language articles obtained using the Medline, Embase, Web of Science and Scopus databases. Additional studies were identified by searching bibliographies in the British Library and abstracts presented at the Association for Research in Vision and Ophthalmology annual meetings. Search terms included randomized controlled trial, controlled clinical trial, random allocation, double-blind method, matched studies and trabeculectomy failure, glaucoma-filtering operation failure, bleb failure and cataract surgery or phacoemulsification. Only prospective or retrospective matched studies testing the survival of a trabeculectomy alone versus clear corneal phacoemulsification after a trabeculectomy in patients with glaucoma were included. Data were independently extracted by two authors using predefined data fields. PubMed yielded 152 results, Scopus 235, Embase 222, and Web of Science (science citation index) 216. We read the abstracts of all the trials, and after reading the full text of 31 studies, we decided that 13 studies should be comprehensively evaluated. Current evidence does not allow us to draw safe conclusions on the scientific question so far.
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Affiliation(s)
- Vasileios G Peponis
- Ophthalmiatreio Athens Eye Hospital, Second Ophthalmology Department, Athens, Greece
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Walland MJ, Parikh RS, Thomas R. There is insufficient evidence to recommend lens extraction as a treatment for primary open-angle glaucoma: an evidence-based perspective. Clin Exp Ophthalmol 2011; 40:400-7. [PMID: 21668783 DOI: 10.1111/j.1442-9071.2011.02617.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cataract extraction in primary open-angle glaucoma has not been thought to provide a clinically useful or predictable decrease in IOP. This concept has now been challenged, with the opposite belief being promulgated: namely, that lens exchange should be considered as treatment for glaucoma. This revelation could bring a significant change in the glaucoma treatment paradigm. There are no randomised controlled trials to guide the role of lens extraction in primary open-angle glaucoma. The available evidence suggests at most a modest reduction in IOP from cataract extraction - greater in the presence of pseudoexfoliation - which is likely to be of marginal benefit, and only in milder forms of open-angle glaucoma. There is currently no evidence of any quality to suggest that lens extraction routinely represents a clinically useful treatment for primary open-angle glaucoma.
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Affiliation(s)
- Mark J Walland
- Glaucoma Investigation and Research Unit, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.
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Lteif Y, Berete-Coulibaly R, Labbé A, Bouassida W, Lachkar Y. [Mid-term effects of two-site phacotrabeculectomy with limbal-based conjunctival flap and microincision trabeculectomy with adjustable sutures]. J Fr Ophtalmol 2008; 31:397-404. [PMID: 18563039 DOI: 10.1016/s0181-5512(08)71434-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the midterm effects of two-site phacotrabeculectomy with limbal-based conjunctival flap and microincisinal trabeculectomy with adjustable sutures. DESIGN and method: The charts of 115 patients (188 eyes) were retrospectively reviewed. Patients had a mean age of 74.7 years and were all operated by the same surgeon between 2001 and 2003. The surgery consisted of a clear cornea phacoemulsification and a microtrabeculectomy with limbal-based conjunctival flap. The number of sutures on the scleral flap was adjusted according to the filtration. RESULTS The mean preoperative IOP was 17.7 +/- 3.94 mmHg, and the mean number of antiglaucomatous medications was 2.05 +/- 0.86. The last postoperative IOP was 13.2 +/- 2.81 mmHg with a mean of 0.8 +/- 0.8 medications. Mean follow-up was 29.8 months (1-7 years). Visual acuity improved by at least two lines in 154 eyes (81%), stabilized (+/- 1 line) in 33 eyes (17.37%), and worsened of more than two lines in one eye (1.63%). Early postoperative complications were seven Seidels (3.68%), one shallow anterior chamber (0.55%), three chorioretinal detachments (1.58%), six hyphemas (3.15%), one iris incarceration (0.55%), and eight corneal edemas (4.21%). Late complications were five cases of bleb fibrosis despite needling and 5-FU injection. We had no cases of wipe-out syndrome. CONCLUSION Our study shows the effectiveness of this special phacotrabeculectomy technique on IOP control and visual acuity improvement, with low complication incidence compared to classical phacotrabeculectomies.
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Affiliation(s)
- Y Lteif
- Institut du Glaucome, Fondation Hôpital Saint-Joseph, Paris.
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Shingleton BJ, Price RS, O'Donoghue MW, Goyal S. Comparison of 1-site versus 2-site phacotrabeculectomy. J Cataract Refract Surg 2006; 32:799-802. [PMID: 16765798 DOI: 10.1016/j.jcrs.2006.01.072] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2005] [Accepted: 11/04/2005] [Indexed: 10/24/2022]
Abstract
PURPOSE To compare the results of 1-site versus 2-site combination glaucoma filtration and phacoemulsification surgery with respect to visual acuity, intraocular pressure (IOP), and glaucoma medication requirements via a case control study. METHODS Results of 2-site phacotrabeculectomy surgery in 64 eyes of 59 patients were retrospectively reviewed with a minimum follow-up of 1 year. The 2-site procedures were compared with a randomly chosen control group of 71 1-site phacotrabeculectomies performed by the same surgeon. RESULTS The presurgical visual acuity, IOP, and glaucoma medication requirements did not differ significantly between the 2 groups. Mean final postoperative results at 1 year for 2-site versus 1-site eyes, respectively, were visual acuity 0.32 +/- 0.353 (SD) and 0.32 +/- 0.37 (P = .99), IOP 15.0 +/- 3.7 mm Hg and 15.1 +/- 6.3 mm Hg (P = .97), and glaucoma medication requirements 0.43 +/- 0.90 and 0.61 +/- 1.1 (P = .52). CONCLUSION There was no statistically significant difference in the final visual acuity, IOP, or glaucoma medication requirements between the 2-site and 1-site groups.
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Inal A, Bayraktar S, Inal B, Bayraktar Z, Yilmaz OF. Intraocular pressure control after clear corneal phacoemulsification in eyes with previous trabeculectomy: a controlled study. ACTA ACUST UNITED AC 2005; 83:554-60. [PMID: 16187992 DOI: 10.1111/j.1600-0420.2005.00497.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare intraocular pressure (IOP) control in eyes with or without clear corneal phacoemulsification following trabeculectomy. METHODS The study group included 30 eyes that underwent uneventful clear corneal phacoemulsification and foldable intraocular lens implantation following trabeculectomy without antimetabolites. Thirty eyes that had undergone filtering surgery without cataract extraction were selected as controls. Case and control groups were matched with respect to age, gender, IOP, number of glaucoma medications, glaucoma type (primary open-angle glaucoma/pseudoexfoliative glaucoma), trabeculectomy time and follow-up. Comparisons between the study and control groups (intergroup) and within the same group at different time-points (intragroup) were performed for IOP, glaucoma medications and bleb morphology. Success rates were investigated by Kaplan-Meier survival analysis and the factors influencing final success by logistic regression. RESULTS Intraocular pressure (p = 0.04) and glaucoma medications (p = 0.001) increased during an average follow-up of 26.1 +/- 9.9 months in both groups. Intragroup differences became statistically significant after the 6-month visit, but intergroup differences remained insignificant. Bleb height decreased significantly following phacoemulsification in the study group (p = 0.017). Success rates decreased with time in both groups, with no intergroup difference (p = 0.46). The final success rate was negatively correlated with IOP and number of glaucoma medications used at the study entry, while there was a positive correlation between the baseline and final success rates. CONCLUSION Trabeculectomy success decreased in a time-dependent manner in eyes with and without subsequent phacoemulsification. Uncomplicated clear corneal phacoemulsification was not found to have any additional unfavorable influence on IOP control in eyes with filtering blebs.
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Affiliation(s)
- Asli Inal
- Beyoğlu Eye Education and Research Hospital, Istanbul, Turkey
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Abstract
PURPOSE To evaluate retrospectively risk indicators for cataract surgery and the effect of phacoemulsification on intraocular pressure (IOP) control in eyes that have undergone trabeculectomy. METHODS We undertook a retrospective analysis of 138 eyes with primary open-angle glaucoma (POAG) or exfoliation glaucoma (EG) in 138 consecutive patients over the age of 40 years undergoing trabeculectomy with no antimetabolites performed by one surgeon. Of the 48 eyes (35%) undergoing a cataract operation during the follow-up period of 2-5 years, 46 were included in this analysis. Their IOP, glaucoma medication and best corrected visual acuity (BCVA) before cataract surgery and at the last follow-up were compared. Risk indicators for cataract surgery were analysed. RESULTS Cataract operations were performed 5.1-58.1 months (median 14.4 months) after trabeculectomy. The mean length of follow-up after cataract surgery was 25.3 months (SD 12.9, median 24.8 months). Before cataract surgery, the mean IOP was 16.2 mmHg (SD 4.9) and the mean number of topical antiglaucoma medicines 0.8 (SD 1.0). At the most recent visit, mean IOP was 17.3 mmHg (SD 6.4) (p = 0.35), and the mean number of medicines was 1.3 (SD 1.1) (p = 0.0007). Of the 22 eyes in which treatment had been categorized as completely successful (IOP < or = 21 mmHg without other therapy) before cataract surgery, 13 (59%) had remained so. The number of failures (IOP > 21 mmHg, or more than one medication needed or further surgery performed) increased from 14 (30%) before surgery to 28 (61%) afterwards. The proportion of failures in the cataract surgery group was twice that in the no cataract surgery group (61% versus 31%). In a proportional hazards regression, only age (73.9 years [SD 9.4] and 68.1 years [SD 9.8] in patients with and without cataract surgery, respectively) proved to be a significant (p = 0.001) indicator for surgery. CONCLUSION The results of this retrospective study on consecutive clinical cases of trabeculectomy indicate that cataract progression after trabeculectomy is mainly an age-related process. In more than half the eyes with good preoperative IOP control, this good control was maintained after cataract surgery. On the other hand, in some eyes cataract surgery may compromise IOP control even when surgery avoids the area of the bleb.
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Affiliation(s)
- Pia Ehrnrooth
- Department of Ophthalmology, University of Helsinki, Helsinki, Finland.
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Effect of incision size and location on postoperative IOP with pseudoexfoliation syndrome. J Cataract Refract Surg 2004. [DOI: 10.1016/j.jcrs.2004.02.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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