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Rao A, Cruz RD. Trabeculectomy: Does It Have a Future? Cureus 2022; 14:e27834. [PMID: 36110452 PMCID: PMC9462599 DOI: 10.7759/cureus.27834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2022] [Indexed: 11/30/2022] Open
Abstract
The trabeculectomy (TRAB) procedure has undergone various modifications to increase the long-term surgical success and safety profiles. The main issues with TRAB include short and long-term complications, that are more common with the concomitant use of anti-fibrotic agents. While many surgeons have predicted the demise of trabeculectomy amidst newer non-penetrating glaucoma surgeries, it is still the gold standard procedure for patients with an advanced or rapidly progressing disease and for those patients who need very low intraocular pressures. This review article is unique in summarizing the evolution of trabeculectomy and its efficacy compared to neoteric shunt procedures while trying to predict if trabeculectomy has a future in the modern surgical world. We have compared the outcomes and complications of trabeculectomy to all the surgical procedures available to date and have tried to evolve an algorithm to help surgeons to decide on their preferred technique.
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Sacchi M, Monsellato G, Villani E, Lizzio RAU, Cremonesi E, Luccarelli S, Nucci P. Intraocular pressure control after combined phacotrabeculectomy versus trabeculectomy alone. Eur J Ophthalmol 2021; 32:327-335. [PMID: 33685259 DOI: 10.1177/1120672121999997] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE We compared the efficacy and safety of trabeculectomy and phacotrabeculectomy in patients with glaucoma. MATERIALS AND METHODS We retrospectively analyzed consecutive patients who underwent trabeculectomy or phacotrabeculectomy. Patients in the trabeculectomy group were pseudophakic. We established three different intraocular pressure (IOP) thresholds (A: <21 mmHg, B: <18 mmHg, and C: <15 mmHg) to measure complete (without medication) and qualified (with medication) success. Success criteria were analyzed through Kaplan-Meier survival curves. RESULTS Sixty-seven eyes were included (40 trabeculectomy, 27 phacotrabeculectomy). The mean follow-up period was 25.70 ± 14.439 months. The baseline characteristics were similar between the groups. The complete and qualified success rates according to criterion C were significantly higher in the trabeculectomy group (p = 0.033, p = 0.021, respectively); however, there was a trend toward a higher success rate for all criteria in favor of trabeculectomy. Bleb needling was more frequent in the phacotrabeculectomy group. The mean IOP significantly decreased from 26.46 ± 7.07 to 12.27 ± 4.06 at 12 months (p < 0.001). The final mean IOP was significantly lower in the trabeculectomy than in the phacotrabeculectomy group (10.95 ± 3.08 vs 13.00 ± 4.56, p = 0.0003). CONCLUSION In pseudophakic eyes, trabeculectomy alone achieves a higher success rate, lower mean IOP, and less frequent bleb needlings. More frequent follow-up and prolonged postoperative use of high-dose topical steroids should be considered in patients undergoing phacotrabeculectomy.
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Affiliation(s)
- Matteo Sacchi
- University Eye Clinic, San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy
| | - Gianluca Monsellato
- University Eye Clinic, San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy
| | - Edoardo Villani
- University Eye Clinic, San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy.,Department of Clinical Science and Community Health, University of Milan, Milan, Italy
| | | | - Elena Cremonesi
- University Eye Clinic, San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy
| | - Saverio Luccarelli
- University Eye Clinic, San Giuseppe Hospital, IRCCS Multimedica, Milan, Italy
| | - Paolo Nucci
- Department of Clinical Science and Community Health, University of Milan, Milan, Italy
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Comparative Efficacy of Phacotrabeculectomy versus Trabeculectomy with or without Later Phacoemulsification: A Systematic Review with Meta-Analyses. J Ophthalmol 2021; 2021:6682534. [PMID: 33628478 PMCID: PMC7896844 DOI: 10.1155/2021/6682534] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/09/2021] [Indexed: 12/14/2022] Open
Abstract
There is no consensus on the surgical management of coexisting cataract in patients who undergo glaucoma surgery. In this study, we systematically reviewed the literature to compare the efficacy and safety of phacotrabeculectomy and trabeculectomy either alone or followed by later phacoemulsification. We systematically searched the literature databases PubMed/MEDLINE, EMBASE, and the Cochrane Central. Eligible studies were comparative trials of eyes with glaucoma that underwent either phacotrabeculectomy or trabeculectomy with or without later phacoemulsification. Our primary outcome measure was intraocular pressure (IOP) control closest to 12 months. Secondary outcome measures were efficacy closest to 12 months in terms of visual acuity, visual field, prevalence of complications, needling or revision, number of antiglaucomatous medications, and surgical success. We identified 25 studies with a total of 4,749 eyes. The IOP did not differ significantly between those who underwent phacotrabeculectomy versus trabeculectomy with (MD: 0.63, CI95%: −0.32, 1.59, p=0.19) or without later phacoemulsification (MD: −0.52, CI95%: −1.45, 0.40, p=0.27). However, phacotrabeculectomy was associated with lower risk of complications (RR: 0.80, CI95%: 0.67, 0.95, p=0.01) and better visual acuity corresponding to a 1.4-line difference (MD: −0.14, CI95%: −0.27, −0.95, p=0.03) compared to trabeculectomy. Other secondary outcome measures did not differ significantly (visual field, needling or revision, number of antiglaucomatous medications, and surgical success). In conclusion, postoperative IOP is comparable, and the number of complications is lower when phacotrabeculectomy is compared to trabeculectomy with or without later phacoemulsification in patients with coexisting glaucoma and cataract. However, our study also reveals that the level of evidence is low, and randomized clinical trials are warranted.
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Aslan F, Öktem Ç. Does adjuvant intracameral triamcinolone acetonide increase the effectiveness of phacotrabeculectomy? A Case-Control Study. CESKÁ A SLOVENSKÁ OFTALMOLOGIE : CASOPIS CESKÉ OFTALMOLOGICKÉ SPOLECNOSTI A SLOVENSKÉ OFTALMOLOGICKÉ SPOLECNOSTI 2020; 76:68-76. [PMID: 33126801 DOI: 10.31348/2020/14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS To investigate the effect of intracameral triamcinolone acetonide (TA) on surgical success in 5-fluorouracil (5-FU) supported primary phacotrabeculectomy (PT) cases. MATERIAL AND METHODS This retrospective study included 23 eyes (study group) of 23 patients who underwent TA during PT and 26 eyes (control group) of 26 patients without TA. PT patients in the study group received 1 mg TA intraoperatively at the end of surgery. Pre- and postoperative visual acuity, intraocular pressure (IOP), and number of antiglaucoma drugs used were compared. Postoperative complications and need for 5-FU injection were evaluated for both groups. RESULTS Mean age was 64.1 2 ± 1.91 (48-86) years in the control group and 66.52 ± 2.02 (52-86) years in the study group (p = 0.824). Comparison of pre- and postoperative IOP values showed significant decreases in postoperative IOP levels at all-time points in both the control and study groups (p < 0.001). The only significant difference between groups was on postoperative first day (study group: 9.22 ± 1.41 mmHg; control group: 6.35 ± 2.17 mmHg, p < 0.001). Need for postoperative 5-FU injection was significantly more common in the control group (p = 0.023). CONCLUSION Intracameral injection of 1 mg TA at the end of PT surgery did not yield superior results in postoperative IOP compared to PT alone, and the two groups showed similar IOP reduction. When given as an adjunct to PT, 1 mg TA suppresses anterior segment inflammation and reduces the need for 5-FU injection.
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Improvement of the Safety Profile of Canaloplasty and Phacocanaloplasty: A Review of Complications and Their Management. J Ophthalmol 2020; 2020:8352827. [PMID: 32612854 PMCID: PMC7315305 DOI: 10.1155/2020/8352827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 05/29/2020] [Indexed: 11/17/2022] Open
Abstract
Research on the methods used to achieve persistent and safe control of intraocular pressure resulted in the implementation of novel surgical procedures, such as canaloplasty and phacocanaloplasty. Herein, we review the literature focused on the safety profile of canaloplasty and phacocanaloplasty and the management of related complications. The aim of canaloplasty is to restore the natural aqueous outflow. This goal is achieved via a surgical procedure that involves viscocanalostomy with catheterisation of Schlemm's canal (360°) and placement of a circumferential suture that tensions the canal walls. This improves Schlemm's canal drainage, choroidoscleral flow, and subconjunctival filtration. The efficacy of canaloplasty for reducing the intraocular pressure is similar to those of trabeculectomy with mitomycin C and deep sclerectomy augmented with an implant and mitomycin C. However, canaloplasty is associated with a lower complication rate than those conventional techniques. Novel microsurgical techniques for the treatment of glaucoma are unlikely to replace the conventional methods. However, these new techniques offer alternatives, especially for patients who have an early indication for surgical intervention. Nevertheless, canaloplasty is associated with the expectations of efficient, safe, and modern surgical treatment.
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Kim WJ, Kim JM, Kim KN, Kim CS. Effect of Preoperative Factor on Intraocular Pressure after Phacoemulsification in Primary Open-angle Glaucoma and Primary Angle-closure Glaucoma. KOREAN JOURNAL OF OPHTHALMOLOGY 2019; 33:303-314. [PMID: 31389206 PMCID: PMC6685830 DOI: 10.3341/kjo.2018.0135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/27/2019] [Accepted: 03/05/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare the effects of cataract surgery on intraocular pressure (IOP) according to preoperative factor in primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). Methods The medical records of 75 POAG and 95 PACG patients who underwent cataract surgery were reviewed. We classified POAG patients with a preoperative peak IOP of less than 31 mmHg and less than three medications used before surgery and PACG patients with a peak IOP of less than 42 mmHg, less than three medications used, and peripheral anterior synechiae of less than four clock hours into group 1. Patients with levels exceeding these thresholds were classified into group 2. The IOP, numbers of medications, and success rates were compared between two groups. Results At 36 months after surgery, IOP reduction in group 1 was significantly greater than that in group 2 among POAG patients (−1.7 ± 2.1 vs. −0.6 ± 2.0 mmHg, p = 0.021); however, there was no significant difference between the two groups for PACG patients (−2.5 ± 2.0 vs. −2.2 ± 3.3 mmHg, p = 0.755). The medication changes were similar between the two groups for both POAG and PACG patients. The success rate at 36 months was significantly higher in group 1 than in group 2 for POAG patients (66.7% vs. 35.7%, p = 0.009), but there was no significant difference between the two groups for PACG patients (79.1% vs. 69.2%, p = 0.264). Conclusions For patients with relatively low peak IOP who used fewer medications before surgery, cataract surgery alone was effective for IOP control in both POAG and PACG patients. Conversely, For POAG patients with a history of higher peak IOP and who used more medications, cataract surgery was not effective in lowering IOP, whereas it resulted in relatively good IOP values in PACG patients.
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Affiliation(s)
- Woo Jin Kim
- Department of Ophthalmology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Ju Mi Kim
- Department of Ophthalmology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Kyoung Nam Kim
- Department of Ophthalmology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Chang Sik Kim
- Department of Ophthalmology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea.
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E. Graf N, Müller M, Gerlach F, M. Meyer L, Philipp S, Distelmaier P, Klink T, Schönfeld CL. Comparison of 2-year-results of mitomycin C-augmented trabeculectomy with or without cataract extraction in glaucoma patients. Can J Ophthalmol 2019; 54:347-354. [DOI: 10.1016/j.jcjo.2018.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 06/28/2018] [Accepted: 07/10/2018] [Indexed: 11/27/2022]
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Hasanov JV, Kasimov EM. [Late results of phaco-canaloplasty in patients with concomitant advanced pseudoexfoliation glaucoma and cataract]. Vestn Oftalmol 2018; 134:28-34. [PMID: 29953079 DOI: 10.17116/oftalma2018134328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess the safety and efficacy of phaco-canaloplasty in patients with concomitant advanced pseudoexfoliation glaucoma and cataract. MATERIAL AND METHODS The study included 56 patients (57 eyes) who underwent phacoanaloplasty guided by Glaucolight microcatheter. All patients were followed up for 48 months. Visual acuity, changes of intraocular pressure (IOP), use of glaucoma medications, incidence of complications, as well as postsurgical interventions were examined. RESULTS Mean preoperative IOP decreased significantly from 29.8 mmHg (15.8-61.6) with a mean of 1.92 (0-3) glaucoma drops to 12.9 mmHg (11.0-19.6) with a mean of 0.12 (0-3) drops respectively 48 months after phacocanaloplasty. Mean visual acuity increased from preoperative 0.15 (0.01-0.8) to 0.6 (0.01-1.2). The most frequent complications included intraoperative perforation of Descemet's membrane (4 eyes, 7%) and hyphema (37 eyes, 65%), IOP spikes (4 eyes, 7%) and inflammation (4 eyes, 7%) in the early postoperative period. CONCLUSION Phacocanaloplasty in eyes with concomitant advanced pseudoexfoliation glaucoma and cataract re-establishes the natural outflow system and leads to significant IOP reduction with minimal risk of intra- and postoperative complications.
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Affiliation(s)
- J V Hasanov
- National Ophthalmology Center named after Zarifa Aliyeva, 32/15 Javadhan St., Baku, Azerbaijan, 1114
| | - E M Kasimov
- National Ophthalmology Center named after Zarifa Aliyeva, 32/15 Javadhan St., Baku, Azerbaijan, 1114
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Jiang L, Eaves S, Dhillon N, Ranjit P. Postoperative outcomes following trabeculectomy and nonpenetrating surgical procedures: a 5-year longitudinal study. Clin Ophthalmol 2018; 12:995-1002. [PMID: 29872259 PMCID: PMC5973473 DOI: 10.2147/opth.s163247] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To assess and compare the long-term postoperative outcomes of trabeculectomy (TE), phacotrabeculectomy (PTE), and viscocanalostomy (VC) and to correlate postoperative intraocular pressure (IOP) with visual outcome. Patients and methods This retrospective cohort observational study included 520 eyes which underwent TE with mitomycin C (MMC) (n=205), PTE with MMC (n=189), and VC ± combined cataract surgery and MMC (n=126) to control IOP between June 2010 and June 2014 by a single surgeon. Complete success was defined as postoperative IOP <20 mmHg, and qualified success with IOP <20 mmHg with single topical agent. Cases requiring more than one topical agent and/or repeat surgery were considered as failure. Mixed linear regression models were constructed to determine estimated predictive values of demographic data, topical prescriptions, baseline and postoperative IOP, and optical assessment (ie, best-corrected visual acuity and mean deviation) profile. Results Follow-up ranged from 12 to 66 months (mean 26 months). At last follow-up, 139 (93.9%), 118 (91.5%), and 98 (94.2%) eyes achieved complete success in TE, PTE, and VC groups, respectively (p=0.0007). Failure rates were 2.7%, 3.9%, and 2.9% following TE, PTE, and VC, respectively (p=0.0052). The between-group difference of mean IOP reduction was greater in the short term (p=0.0002). Good postoperative IOP control correlates to optical outcomes reflected by best-corrected visual acuity and mean deviation following TE (β = −4.7577, p=0.0384) and PTE (β = −4.5083, p=0.02741). Conclusion Significant association was observed between good postoperative IOP control and optical outcome. TE remains the more effective surgical intervention for sustained lowering of IOP. Most complications were transient and self-limiting.
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Affiliation(s)
- Li Jiang
- Ophthalmology Department, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Scott Eaves
- Ophthalmology Department, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Navpreet Dhillon
- Ophthalmology Department, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Punithawathy Ranjit
- Ophthalmology Department, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
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Lee JS, Lee CE, Park JH, Seo S, Lee KW. Refractive Error Induced by Combined Phacotrabeculectomy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2018. [DOI: 10.3341/jkos.2018.59.12.1173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
| | - Chong Eun Lee
- Department of Ophthalmology, Keimyung University School of Medicine, Daegu, Korea
| | | | - Sam Seo
- Cheil Eye Hospital, Daegu, Korea
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European Glaucoma Society Terminology and Guidelines for Glaucoma, 4th Edition - Chapter 3: Treatment principles and options Supported by the EGS Foundation: Part 1: Foreword; Introduction; Glossary; Chapter 3 Treatment principles and options. Br J Ophthalmol 2017; 101:130-195. [PMID: 28559477 PMCID: PMC5583689 DOI: 10.1136/bjophthalmol-2016-egsguideline.003] [Citation(s) in RCA: 179] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Fan Gaskin JC, Sandhu SS, Walland MJ. Victorian trabeculectomy audit. Clin Exp Ophthalmol 2017; 45:695-700. [DOI: 10.1111/ceo.12948] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 02/15/2017] [Accepted: 03/09/2017] [Indexed: 12/28/2022]
Affiliation(s)
- Jennifer C Fan Gaskin
- Centre for Eye Research Australia; Melbourne Victoria Australia
- The Royal Victorian Eye and Ear Hospital; Melbourne Victoria Australia
| | - Sukhpal S Sandhu
- Centre for Eye Research Australia; Melbourne Victoria Australia
- The Royal Victorian Eye and Ear Hospital; Melbourne Victoria Australia
| | - Mark J Walland
- Centre for Eye Research Australia; Melbourne Victoria Australia
- The Royal Victorian Eye and Ear Hospital; Melbourne Victoria Australia
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Dhalla K, Cousens S, Murdoch IE. Phacoemulsification compared with phacotrabeculectomy surgery: a within-person observational cohort study. Br J Ophthalmol 2017; 101:1628-1632. [PMID: 28416493 DOI: 10.1136/bjophthalmol-2015-307837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 03/02/2017] [Accepted: 03/19/2017] [Indexed: 11/03/2022]
Abstract
AIM To compare reduction in intraocular pressure (IOP) and gain in visual acuity (VA) following phacotrabeculectomy (PT) and phacoemulsification(phaco) in Tanzanian patients with primary open angle glaucoma(POAG). SETTING CCBRT Hospital, Dar es Salaam, Tanzania. DESIGN Within-person observational cohort study. METHODS Within each patient, one eye had PT and the other phaco. Patients were followed for up to 5-1/2 years, and IOP and VA in each eye were assessed. For a small group of patients, two additional postoperative time points were compared. RESULTS 52 patients (34 male) with a mean age of 70 years (SD 8 years) were enrolled in the study. For those with 250 days or more follow-up, both operations resulted in lower IOPs and improved VA (p<0.001). The average drop in IOP was 50% (95%CI 45% to 55%) for PT and 41% (95% CI 36% to 46%) for phaco. Mean IOP was lower in the PT group 12.9 mm Hg vs 16.8 mm Hg (p=0.004). Extended follow-up in nine patients showed a rise in IOP of 1.8 mm Hg for PT and 4.2 mm Hg for phaco eyes between first (mean, 337 days) and second (mean 1482 days) follow-up (p=0.18). CONCLUSION In this small study in African patients, PT resulted in lower IOPs than phacoemulsification alone but the difference between the procedures was relatively small. Phacoemulsification alone was effective in reducing IOP and improving VA for several years in this population. Given the relative simplicity of phacoemulsification, it is a therapeutic option worthy of consideration in some settings.
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Affiliation(s)
- Kazim Dhalla
- Department of Ophthalmology, Comprehensive Community Based and Rehabilitation in Tanzania (CCBRT) - Hospital, Dar es Salaam, United Republic of Tanzania
| | - Simon Cousens
- Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Ian E Murdoch
- Department of Genetics, The Institute of Ophthalmology, London, UK.,Moorfields Eye Hospital, London, UK
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Dhalla K, Cousens S, Bowman R, Wood M, Murdoch I. Is Beta Radiation Better than 5 Flurouracil as an Adjunct for Trabeculectomy Surgery When Combined with Cataract Surgery? A Randomised Controlled Trial. PLoS One 2016; 11:e0161674. [PMID: 27606611 PMCID: PMC5015865 DOI: 10.1371/journal.pone.0161674] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 07/30/2016] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION In an African setting surgery is generally accepted as the treatment of first choice for glaucoma. A problem with trabeculectomy surgery for the glaucomas is the frequent co-existence and exacerbation of cataract. We report a randomized controlled trial to compare the use of beta radiation with 5FU in combined cataract and glaucoma surgery. PARTICIPANTS AND METHODS Consenting adults aged >40 years with glaucoma, an IOP>21mmHG and cataract were enrolled and randomised to receive either 1000cG β radiation application or sub-conjunctival 5fluorouracil (5FU) at the time of combined trabeculectomy and phaco-emulsification with lens implant surgery. RESULTS 385 individuals were eligible for inclusion of whom 301 consented to inclusion in the study (one eye per patient). 150 were randomised to the 5FU arm and 151 received β radiation. In the 12 months following surgery there were 40 failures (IOP>21mmHg) in the 5FU arm and 34 failures in the beta arm. The hazard ratio for the beta radiation arm compared to the 5FU arm, adjusted for IOP at baseline, was 0.83 (95% c.i. 0.54 to 1.28; P = 0.40). The improvement from mean presenting visual acuities of 0.91 and 0.86 logMAR to 0.62 and 0.54 in the 5FU and beta arms respectively was comparable between groups (P = 0.4 adjusting for baseline VA). Incidence of complications did not differ between the two groups. DISCUSSION This study highlights several important issues in the quest for a therapeutic strategy for the glaucomas in an African context. Firstly, there is no evidence of an important difference between the use of 5FU and beta radiation as an anti-metabolite in phacotrabeculectomy. Secondly phacotrabeculectomy is a successful operation that improves visual acuity as well as controlling IOP in a majority of patients. Although the success of trabeculectomy in lowering IOP is reduced when combined with phacoemulsification compared with trabeculectomy alone, this finding has to be set against the possible need for subsequent cataract surgery following trabeculectomy alone, which represents a second trip and expense for the patient and results in 10-61% failure of the trabeculectomy at one year post-cataract surgery. TRIAL REGISTRATION ISRCTN Registry ISRCTN36436933.
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Affiliation(s)
- Kazim Dhalla
- Department of Ophthalmology, Comprehensive Community Based Rehabilitation Hospital in Tanzania (CCBRT), Dar Es Salaam, Tanzania
| | - Simon Cousens
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Richard Bowman
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Mark Wood
- Department of Ophthalmology, Comprehensive Community Based Rehabilitation Hospital in Tanzania (CCBRT), Dar Es Salaam, Tanzania
| | - Ian Murdoch
- Institute of Ophthalmology, University College of London, London, United Kingdom
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Comparison of ExPress Mini-Device Implantation Alone or Combined with Phacoemulsification for the Treatment of Open-Angle Glaucoma. J Ophthalmol 2015; 2015:613280. [PMID: 26576293 PMCID: PMC4630402 DOI: 10.1155/2015/613280] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 09/22/2015] [Accepted: 09/27/2015] [Indexed: 11/17/2022] Open
Abstract
We propose comparative assessment of the effectiveness of two surgical methods for the treatment of open-angle glaucoma: (1) ExPress mini-device implantation combined with phacoemulsification and (2) ExPress mini-device implantation alone.
In this prospective study, 81 patients (88 phakic eyes) with uncontrolled open-angle glaucoma enrolled for surgery. They were assigned two groups, those with coexisting cataracts (46 eyes; P-ExPress group) and those with glaucoma alone (42 eyes; ExPress group). The follow-up period was 12.9 ± 0.4 months in P-ExPress and 12.2 ± 0.6 months in ExPress group. In both groups the following parameters were measured: best corrected visual acuity (BCVA), intraocular pressure (IOP), number of complications and necessary postoperative interventions, and number of glaucoma medications. The IOP at the end of follow-up was similar in both groups (18.8 ± 5.9 versus 18.1 ± 4.8 mmHg; P = 0.814). There were no statistical differences in the average number of glaucoma medications between ExPress and P-ExPress groups (0.9 ± 1.65 versus 1.3 ± 1.7; P = 0.419) as well as in the number of postoperative complications (26 versus 21%; P = 0.179 in the P-ExPress and ExPress groups, resp.). Both methods are safe and effective for the surgical treatment of open-angle glaucoma. Coexistence of cataracts does not constitute a compelling contraindication for combined surgery.
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Phacoemulsification and intraocular lens implantation before, during, or after canaloplasty in eyes with open-angle glaucoma: 3-year results. J Glaucoma 2015; 24:187-94. [PMID: 23429620 DOI: 10.1097/ijg.0b013e318285ff13] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To report 3-year results evaluating the effect on safety and efficacy of canaloplasty to treat open-angle glaucoma when combined with cataract surgery. PATIENTS AND METHODS This was a retrospective subset analysis of a prospective, international, multicenter study evaluating 133 eyes of 133 adult, open-angle glaucoma patients who underwent canaloplasty with tensioning suture placement. Eighty-two phakic eyes that received canaloplasty alone were compared with 51 eyes that underwent cataract surgery before or during canaloplasty. RESULTS Phakic eyes that received combined cataract-canaloplasty surgery (phacocanaloplasty) had a mean±SD baseline IOP of 23.5±5.2 mm Hg and mean glaucoma medication usage of 1.5±1.0 decreasing to a mean IOP of 13.6±3.6 mm Hg on 0.3±0.5 medications at 3 years postoperatively. Pseudophakic eyes undergoing canaloplasty had a mean baseline IOP of 23.9±5.2 mm Hg on a mean of 1.8±0.8 glaucoma medications decreasing to 15.6±3.5 mm Hg on 1.1±0.8 medications at 3 years. In phakic eyes, reductions in IOP were significantly greater and less postoperative IOP lowering medication was needed after undergoing phacocanaloplasty compared to eyes which had canaloplasty alone. CONCLUSIONS Clear corneal phacoemulsification performed before or in combination with canaloplasty is a safe and effective surgical procedure to reduce IOP in adult patients with open-angle glaucoma.
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Heo DW, Kim CS. Comparison of Filtering-Bleb Survival and Intraocular Pressure between Combined Phacotrabeculectomy and Trabeculectomy in Primary Glaucomas. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2012. [DOI: 10.3341/jkos.2012.53.12.1835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Dong Won Heo
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Chang Sik Kim
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Korea
- Research Institute for Medical Science, Chungnam National University, Daejeon, Korea
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Abstract
Purpose To evaluate to what extent contemporary glaucoma abstracts offer complete information and to suggest a new manner of pressure results reporting. Materials, methods, and results Most of the 36 relevant surgical glaucoma abstracts found in one issue of International Glaucoma Review contain insufficient data-supported statements. Such abstracts cannot offer a clear picture of the study essence if economic, linguistic, or political barriers prevent access to the full text. In order to enrich abstract content and to avoid typographic space waste, a formula is suggested to provide, in one single line of symbols and figures, all the necessary data for statistical interpretation at two evolution moments: the first significative control (6 months) and the final one. Conclusion The current manner of results reporting in surgical glaucoma abstracts is subject to too little standardization, allowing insufficiently data-supported statements. Abstracts, especially those printed in small-circulation language journals, should be conceived and standardized in such a manner that any abstract review reader is capable of grasping the essence of the study at first glance. The suggested manner of reporting results would bring satisfaction to all areas of the process. Publishers would save typographic space, readers would find all the necessary data for statistical analysis and comparison with other studies, and authors would be convinced that the essence of their work would penetrate in spite of any economic, linguistic, or political barriers.
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Canaloplasty: Three-year results of circumferential viscodilation and tensioning of Schlemm canal using a microcatheter to treat open-angle glaucoma. J Cataract Refract Surg 2011; 37:682-90. [DOI: 10.1016/j.jcrs.2010.10.055] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 10/11/2010] [Accepted: 10/28/2010] [Indexed: 11/23/2022]
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Combined cataract and trabeculectomy surgery for advanced glaucoma in East Africa; visual and intra-ocular pressure outcomes. Eye (Lond) 2009; 24:573-7. [DOI: 10.1038/eye.2009.132] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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Shingleton B, Tetz M, Korber N. Circumferential viscodilation and tensioning of Schlemm canal (canaloplasty) with temporal clear corneal phacoemulsification cataract surgery for open-angle glaucoma and visually significant cataract. J Cataract Refract Surg 2008; 34:433-40. [DOI: 10.1016/j.jcrs.2007.11.029] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2007] [Accepted: 11/01/2007] [Indexed: 11/29/2022]
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Rotchford AP, Vernon SA. Phaco-microtrabeculectomy: technique and intraocular pressure control in comparison with microtrabeculectomy. Clin Exp Ophthalmol 2008; 35:812-7. [PMID: 18173408 DOI: 10.1111/j.1442-9071.2007.01604.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To describe a modified technique for combined cataract and glaucoma drainage surgery involving a small flap (micro) trabeculectomy combined with phaco-emulsification (PMT). To assess the level of intraocular pressure (IOP) control achieved by this procedure in comparison with microtrabeculectomy (MT) alone. METHODS In this retrospective controlled case series records were reviewed for 37 consecutive low-risk patients undergoing PMT augmented with 5-fluorouracil (5-FU) and 37 low-risk subjects undergoing MT with 5-FU. IOP control was compared by survival analysis using IOP targets < or = 21 mmHg and < or = 16 mmHg at final follow up and with at least a 25% reduction from the preoperative pressure. RESULTS Mean follow up was 41.7 months (range 19.0-72.0) in the PMT group and 43.5 months (range 18.0-66.0) in the MT group. A final IOP < or = 21 mmHg and with at least a 25% reduction from the preoperative pressure was achieved in 91.9% patients undergoing PMT (70.3% on no glaucoma drops). IOP < or = 16 mmHg and with at least a 25% reduction from the preoperative pressure was achieved in 67.6% (56.8% without drops). There were no significant differences in survival rates between PMT and MT for either IOP target. The mean final IOPs were 13.4 and 13.5 mmHg on a mean of 0.6 and 0.8 glaucoma drops in the PMT and MT groups, respectively. In the PMT final visual acuity improved by at least one Snellen line in 81.1% and was worse in a single eye. CONCLUSIONS IOP control following combined surgery by PMT is as good as following MT alone.
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Affiliation(s)
- Alan P Rotchford
- Department of Ophthalmology, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK.
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Lewis RA, von Wolff K, Tetz M, Korber N, Kearney JR, Shingleton B, Samuelson TW. Canaloplasty: Circumferential viscodilation and tensioning of Schlemm's canal using a flexible microcatheter for the treatment of open-angle glaucoma in adults. J Cataract Refract Surg 2007; 33:1217-26. [PMID: 17586378 DOI: 10.1016/j.jcrs.2007.03.051] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2006] [Accepted: 03/22/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of circumferential viscodilation and tensioning of the inner wall of Schlemm's canal in a new surgical procedure for the treatment of open-angle glaucoma (OAG). SETTING Fourteen clinical sites in the United States and Germany. METHODS In this international multicenter prospective study of adult patients with OAG having glaucoma surgery, patients with qualifying preoperative intraocular pressure (IOP) of at least 16 mm Hg or higher and open angles were eligible. Evaluation was performed at baseline and 1 day, 1 week, and 1, 3, 6, and 12 months preoperatively. After a nonpenetrating dissection technique to expose Schlemm's canal was performed, a flexible microcatheter (iTrack 250A, iScience Interventional) was used to dilate the full circumference of the canal by injecting sodium hyaluronate 1.4% (Healon GV) during catheterization. A suture loop was placed in the canal to apply tension to the trabecular meshwork. High-resolution ultrasound imaging was used to assess Schlemm's canal and anterior segment angle morphology, including distension of the trabecular meshwork caused by the tensioning suture. Data analysis was performed in 2 groups: Group 1, in which patients met all inclusion criteria, and Group 2, made up of Group 1 patients who had successful suture placement. RESULTS Group 1 comprised 94 patients and Group 2, 74 patients. The mean baseline IOP in Group 1 was 24.7 mm Hg+/-4.8 (SD) on a mean of 1.9+/-1.0 medications per patient. In Group 2 (patients with sutures), the mean IOP was 16.1+/-4.7 mm Hg 3 months postoperatively, 15.6+/-4.0 mm Hg at 6 months, and 15.3+/-3.8 mm Hg at 1 year. Medication use dropped to a mean of 0.6+/-0.9 per patient at 12 months. Suture tensioning was an apparent contributing factor in achieving surgical success. Patients with measurable trabecular meshwork distension from suture tension had a mean IOP of 15.9+/-5.2 mm Hg at 6 months and 14.5+/-3.0 mm Hg at 12 months. Surgical and postsurgical adverse events were reported in 15 of 94 patients (16%) and included hyphema (3), elevated IOP greater than 30 mm Hg (3), Descemet's tear (1), hypotony (1), choroidal effusion (1), and exposed closure suture with eyelid edema and erythema epiphora (1); 4 patients were subsequently converted to trabeculectomy. CONCLUSION Circumferential viscodilation and tensioning of Schlemm's canal was a safe and effective surgical procedure to reduce IOP in adult patients with OAG.
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