Combined cataract and glaucoma surgery

Small-incision phacotrabeculectomy versus phacoemulsification in refractory acute primary angle closure with cataract

Background

Acute primary angle closure (PAC) can be refractory to conventional treatment and intraocular pressure (IOP) is beyond control. Surgical intervention should be considered at the moment. The aim of the study was to compare small-incision phacotrabeculectomy (phacotrab, small-incision trabeculectomy combined with phacoemulsification) with phacoemulsification (phaco) in patients with refractory acute PAC and coexisting cataract.

Methods

Analyzed 49 eyes (49 patients) with acute PAC and cataract received small-incision phacotrab (24 eyes) or phaco (25 eyes) randomly. All these cases were refractory to conventional treatment involved the use of preoperative topical IOP-lowering agents, corticosteroids, mannitol, methazolamide and paracentesis to reduce IOP. The effects on best corrected visual acuity (BCVA), IOP, anterior chamber depth (ACD), glaucoma medications, and complications were observed for twelve months.

Results

After operation BCVA of 18 patients (75 %) in phacotrab group and 20 patients (80 %) in phaco group improved compared to preoperative vision. No statistically significant differences in mean BCVA were found between the two groups. The mean postoperative IOP levels at all follow up time points were lower than the mean preoperative IOP in each group (P <0.001). There was statistically significant difference in mean IOP between the two groups only at 12 months postoperatively (P = 0.006). The surgical success rate (without medications, IOP ≤ 21 mmHg) was 83.33 % (20 eyes) and 72 % (18 eyes) in phacotrab group and phaco group respectively at 12 months. No statistically significant differences in the mean ACD were found between the two groups. There were no serious intra- or post-operative complications in the two treatment groups.

Conclusions

Besides phaco, small incision phacotrab may be another effective and safe choice in the treatment of patients with refractory acute PAC and coexisting cataract. Whether phacotrab is more effective in IOP control in the long term needs to be verified in the further.

Otago Glaucoma Surgery Outcome Study: long term results of cataract extraction combined with Molteno implant insertion or trabeculectomy in primary glaucoma

BACKGROUND/AIMS

To describe the long term results of cases of cataract extraction combined with either Molteno implant insertion or trabeculectomy for primary open angle glaucoma.

METHODS

This prospective case series followed cases which had cataract extraction and Molteno implant insertion (45 eyes) or trabeculectomy (94 eyes) followed up for a mean of 5.3 years and 3.9 years respectively.

RESULTS

Cataract extraction and Molteno implant insertion or trabeculectomy controlled the intraocular pressure at 21 mmHg or less with a probability of 1.00 (95% CI 0.93 to 1.00) at 10 years or more after operation and 0.94 (95% CI 0.89 to 0.99) and 0.73 (95% CI 0.46 to 0.99) at five and 10 years after operation respectively.

CONCLUSIONS

Cataract extraction combined with insertion of Molteno implants or trabeculectomy controlled the intraocular pressure in 100% (45/45) and 94% (88/94) of cases respectively.

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.

Longterm results of one-site phacotrabeculectomy

PURPOSE

To evaluate results of one-site phacotrabeculectomy and intraocular lens (IOL) implantation.

METHODS

A retrospective study of a consecutive series of 62 eyes with cataract and glaucoma, which underwent primary one-site phacotrabeculectomy with IOL implantation. Mean follow-up time was 28 +/- 12.3 months (range 12-46 months).

RESULTS

Preoperative mean intraocular pressure (IOP) (25.1 +/- 8.6 mmHg) dropped significantly, to 16.4 +/- 1.3 mmHg 1 year after surgery (p < 0.01). Mean logMAR best corrected visual acuity (VA) improved significantly from 0.74 +/- 0.49 to 0.22 +/- 0.28 (p < 0.01). The most common complications were fibrinous exudation (10%) and choroidal detachment (6%). In two eyes (3%) we successfully performed scleral flap revision to achieve IOP control.

CONCLUSION

One-site combined surgery was a safe and effective procedure with good IOP control and visual rehabilitation.