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Brízido M, Rodrigues PF, Almeida AC, Abegão Pinto L. Cataract surgery and IOP: a systematic review of randomised controlled trials. Graefes Arch Clin Exp Ophthalmol 2022; 261:1257-1266. [PMID: 36441227 DOI: 10.1007/s00417-022-05911-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/28/2022] [Accepted: 11/11/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Cataract and glaucoma are two of the most common ocular comorbidities. Cataract surgery has been shown to influence intra-ocular pressure (IOP) in patients with glaucoma; nevertheless, the extent of this effect remains controversial, especially in patients with open-angle glaucoma (OAG). The aim of this review is to determine the real effect of cataract surgery on IOP change in patients with OAG, focusing on data retrieved from randomised controlled trials (RCTs). METHODS A systematic review was performed, including six different RCTs that studied the net effect of cataract surgery on IOP. Eligibility criteria required a full washout from hypotensive therapy, allowing accurate measurement of unmedicated IOP, both before and after surgery. RESULTS Included studies revealed a consistent reduction on IOP occurring after surgery, varying between 4.1 and 8.5 mmHg depending on the RCT. There was also a decrease in the number of glaucoma medications, with a mean reduction of 0.2-1.0 agents postoperatively. Evaluation of adverse outcomes of cataract surgery showed a very favourable safety profile. CONCLUSION Although the role of cataract surgery in the algorithm of glaucoma treatment remains to be established, this review highlights a consistent decrease on IOP following surgery and a reduced dependency on glaucoma medications. Potential downgrade in medication can thus be considered in well-controlled glaucoma patients after phacoemulsification. PROSPERO registry: CRD42022343378.
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Affiliation(s)
- Margarida Brízido
- Hospital Beatriz Ângelo, Ophthalmology Department, Av. Carlos Teixeira N 3, 2674-514, Loures, Portugal.
| | - Pedro Filipe Rodrigues
- Hospital Beatriz Ângelo, Ophthalmology Department, Av. Carlos Teixeira N 3, 2674-514, Loures, Portugal
| | - Ana C Almeida
- Hospital Beatriz Ângelo, Ophthalmology Department, Av. Carlos Teixeira N 3, 2674-514, Loures, Portugal
| | - Luís Abegão Pinto
- Centro Hospitalar Universitário Lisboa Norte - Hospital de Santa Maria, Lisbon, Portugal
- Faculdade de Medicina, Universidade de Lisboa, Ophthalmology Department, Lisbon, Portugal
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Primary outcomes of combined cataract extraction technique with Ab-Interno trabeculectomy and endoscopic Cyclophotocoagulation in patients with primary open angle Glaucoma. BMC Ophthalmol 2020; 20:406. [PMID: 33036581 PMCID: PMC7545548 DOI: 10.1186/s12886-020-01643-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 09/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Glaucoma surgery have been developed to lower intraocular pressure in a less invasive manner than traditional glaucoma surgery. The purpose of this article is to determine the outcome of using combined phacoemulsification technique, ab-interno trabeculectomy dual blade and endoscopic cyclophotocoagulation (ECP) surgeries in patients with primary open angle glaucoma. METHODS A retrospective case series was performed on 27 consecutive eyes with both primary open-angle glaucoma (POAG) and cataract; each eye was treated with combined phacoemulsification, ab-interno trabeculectomy-Kahook Dual Blade and Endocyclophotocoagulation at Instituto de ojos Oftalmosalud, Lima, Peru, between April 2017 and May 2017. INCLUSION CRITERIA 1) Patients with uncontrolled mild to advanced POAG (according to Glaucoma Grading Scale HODAPP) 2) cataract condition 3) treatment with two or more glaucoma medications due to rapid progression in the visual fields (at least two in a short period of time). Intraocular pressure (IOP), best corrected visual acuity (BCVA) logMAR and number of glaucoma medications were recorded prior to the study, at day 1, week 1, and 1,3,6 and 9 months after surgery. Primary outcome measure was surgical success defined in terms of IOP < 14 mmHg either with no medications (complete success) or with medications (qualified success). RESULTS A total of 27 eyes from 27 patients were included. The mean basal IOP was 17.0 ± 3.7 mmHg and postoperatively was 11.6 ± 1.9 mmHg and 11.4 ± 1.8 mmHg (P < 0.001) at 6 and 9 months respectively. Glaucoma medications decreased from 1.9 ± 1.4 to 0.56 ± 1.05 at 9 month follow-ups (P < 0.001). Preoperative best corrected visual acuity (BCVA) showed and improvement from 0.4 ± 0.4 LogMAR to 0.2 ± 0.4 logMAR at 9 months. The main complication was blood reflux intra-operatively (66.7%), which resolved without re-operation. The mean IOP was reduced by 32.9% from baseline and the surgical success was 92,6%, (complete success 70,3% and qualified success 29,6%) at 9 months. CONCLUSIONS In patients with POAG, combined treatment with phacoemulsification, ab-interno trabeculectomy and endoscopic cyclophotocoagulation effectively reduced IOP and glaucoma medication dependence.
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Zhou WS, Lin WX, Geng YY, Wang T. Combined phacoemulsification and goniosynechialysis with or without endoscopic cyclophotocoagulation in the treatment of PACG with cataract. Int J Ophthalmol 2020; 13:1385-1390. [PMID: 32953576 DOI: 10.18240/ijo.2020.09.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 02/18/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the efficacy and safety of combined phacoemulsification and goniosynechialysis with or without endoscopic cyclophotocoagulation (PGE group and PG group) for the treatment of patients with coexisting primary angle-closure glaucoma (PACG) and cataracts. METHODS The clinical data of patients with PACG and cataract were retrospectively reviewed. There was a total of 88 eyes in the study and were divided into two groups, 42 eyes in PGE group and 46 eyes in PG group. Surgery success cumulative survival, preoperative and postoperative intraocular pressure (IOP), number of IOP-lowering medications, best corrected visual acuity (BCVA) in the two groups were observed for more than 12mo and compared within each group and between two groups. RESULTS The mean IOP in PGE group declined from 24.9 mm Hg preoperatively to 14.1 mm Hg at the first month after operation (P<0.001) and at the last visit 16.2 mm Hg (P<0.001). Meanwhile PG group also showed significant decrease, from 24.1 mm Hg preoperatively to 13.0 mm Hg at 1mo after operation (P<0.001) and 15.3 mm Hg at the last visit (P=0.004). The mean medications reliance reduced in both groups, in PGE group was reduced from 1.62 preoperatively to 0.13 at the last visit (P<0.001), in PG group from 0.87 to 0.10 (P<0.001). At the last visit, BCVA increased from 0.21 to 0.60 in PGE group (P<0.001) and from 0.24 to 0.67 in PG group (P<0.001). The success rate of PGE group at 1mo was 95.2%, then decreased to 70.7% at the last visit, whereas in PG group, the success rate at 1mo was 100%, at the last visit was 73.4%. CONCLUSION PGE shows promise for PACG patients with cataracts to reduce IOP, lighten the medication burden and improve visual acuity, and PG still has its value in specific patients.
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Affiliation(s)
- Wan-Shu Zhou
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Wen-Xiang Lin
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Yun-Yun Geng
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Tao Wang
- Beijing Tongren Eye Center, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
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Chen HY, Lin CL, Kao CH. Changes in glaucoma medication numbers after cataract and glaucoma surgery: A nationwide population-based study. Medicine (Baltimore) 2019; 98:e14128. [PMID: 30681574 PMCID: PMC6358407 DOI: 10.1097/md.0000000000014128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
To determine whether cataract or glaucoma and combined cataract and glaucoma surgery (CGS) affect glaucoma medication usage.We recruited patients who received new diagnoses of glaucoma, either primary open-angle glaucoma (POAG) (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 365.1) or primary angle-closure glaucoma (PACG) (ICD-9-CM code 365.2), between 1998 and 2011 and had undergone cataract surgery alone (CS), glaucoma surgery alone (GS), or CGS under the National Health Insurance program in Taiwan. CS, GS, and CGS in all the patients were performed after the glaucoma diagnosis date. The patients were subdivided into CS, CGS, and GS groups. The number of glaucoma medications, including prostaglandin analogs, β-blockers, carbonic anhydrase inhibitors, α-agonists, pilocarpine, and a combination of drugs, in each prescription, were compared before and after surgery.The mean number of glaucoma medications in each prescription before the surgery increased from approximately 0.5/1 (CS/CGS + GS) to a peak of 1.75/3 within 3 months before the index date. The mean number of glaucoma medications in each prescription reduced to 0 (CS group) and to approximately 0.5 (CGS and GS) at the end of the 3-year follow-up period. The mean number of glaucoma medications in each prescription significantly reduced at the time points within 6 months, between 6 months and 2 years, and during 2 to 3 years after surgery in each group. At the end of the 3-year period, the reduction effect was most evident in the CS group. Similar trends were also observed in the POAG and PACG group.CS, GS, and CGS significantly reduced the number of glaucoma medications used by the glaucoma patients.
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Affiliation(s)
| | - Cheng-Li Lin
- College of Medicine
- Management Office for Health Data
| | - Chia-Hung Kao
- Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine
- Department of Nuclear Medicine and PET Center, China Medical University Hospital
- Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan
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Masis M, Mineault PJ, Phan E, Lin SC. The role of phacoemulsification in glaucoma therapy: A systematic review and meta-analysis. Surv Ophthalmol 2018; 63:700-710. [DOI: 10.1016/j.survophthal.2017.08.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 08/16/2017] [Accepted: 08/21/2017] [Indexed: 11/28/2022]
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Chang PY, Wang JY, Chang SW, Chang YC. Changes in Ocular Hypotensive Drug Usage for Glaucoma Treatment After Cataract Surgery: A Nationwide Population-based Study in Taiwan. J Glaucoma 2018; 27:600-605. [PMID: 29757810 DOI: 10.1097/ijg.0000000000000969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aims of this study were to observe the changes in the demand for prescriptions of ocular hypertensive drug (OHD) after cataract surgery, to investigate patterns of change in the required OHD amount in open-angle glaucoma (OAG) and angle-closure glaucoma (ACG) cases, and to determine the associated factors related to the change. MATERIALS AND METHODS This population-based cohort study using the Taiwan National Health Insurance Research Database enrolled patients with glaucoma who underwent bilateral cataract surgeries within 2 years between 2001 and 2012. The major dependent variables were the total amounts of OHDs prescribed within 1 year before the first cataract surgery and 1 year after the second cataract surgery. We compared the overall change in the required OHD amount before and after cataract surgery and further explored potential factors affecting the change. RESULTS Among the 440 patients, there were more cases of ACG than OAG (68.6% vs. 31.4%). The total OHD amount prescribed reduced significantly after cataract surgery in patients with OAG (median, from 12 to 6 bottles before and after the surgery, P<0.0001) and ACG (median, from 10 to 3 bottles, P<0.0001), and the reduction was sustained for 5 years. The reduction was significantly larger in patients with ACG and higher demand for OHD (P=0.0157). Among the OAG cases, the reduction was significantly larger in patients who were female individuals (P=0.0138), treated in clinics (P=0.0305), and exhibited high demand for OHD (P=0.0282). CONCLUSIONS The prescriptions of OHDs by glaucoma patients reduced considerably after cataract surgery. Although the reduction proportion of the demand for OHD after cataract surgery was significantly larger in patients with ACG than in those with OAG, the reduction was sustained for 5 years in both types of glaucoma.
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Affiliation(s)
- Pei-Yao Chang
- Department of Ophthalmology, Far Eastern Memorial Hospital, Ban-Chiao, New Taipei.,Department of Ophthalmology, National Taiwan University Hospital, Taipei
| | - Jiun-Yi Wang
- Department of Healthcare Administration, Asia University.,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Shu-Wen Chang
- Department of Ophthalmology, Far Eastern Memorial Hospital, Ban-Chiao, New Taipei.,Department of Ophthalmology, National Taiwan University Hospital, Taipei
| | - Yu-Chia Chang
- Department of Healthcare Administration, Asia University.,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
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Cohen A, Wong SH, Patel S, Tsai JC. Endoscopic cyclophotocoagulation for the treatment of glaucoma. Surv Ophthalmol 2017; 62:357-365. [DOI: 10.1016/j.survophthal.2016.09.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 09/19/2016] [Accepted: 09/29/2016] [Indexed: 12/14/2022]
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Thomas R, Walland M, Thomas A, Mengersen K. Lowering of Intraocular Pressure After Phacoemulsification in Primary Open-Angle and Angle-Closure Glaucoma: A Bayesian Analysis. Asia Pac J Ophthalmol (Phila) 2016; 5:79-84. [PMID: 26886123 DOI: 10.1097/apo.0000000000000174] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Phacoemulsification as treatment for primary open-angle glaucoma (POAG) remains more controversial than for primary angle-closure glaucoma (PACG). If the objective of glaucoma surgery is an additional greater than or equal to 5 to 6 mm Hg reduction of intraocular pressure (IOP), the role of phacoemulsification should be based on the probability of achieving this. A Bayesian analysis of available data was performed to calculate the change in IOP after phacoemulsification in POAG and PACG. Standard meta-analysis formulation with prephacoemulsification and postphacoemulsification IOP-assumed to have normal distributions, with study-specific means and SDs-was used. Absolute and relative change in IOP was calculated using different priors, and sensitivity analyses were performed. The prior that just included a decrease of greater than or equal to 6 mm Hg in the 95% credible interval was identified. The probability of achieving greater than or equal to 5 to 6 mm Hg decrease in IOP (and other levels) was calculated. Depending on the prior, the probability of achieving a greater than or equal to 5 mm Hg reduction in IOP in POAG varied from 0.1% to 3%. Confidence in a greater than or equal to 6 mm Hg decrease required a prior belief that phacoemulsification produces a mean decrease of 7 mm Hg. The probability of a decrease in IOP was greater in PACG: approximately 50% probability of a greater than or equal to 5 mm Hg decrease in PACG uncontrolled on medications. Phacoemulsification in POAG has a high probability of producing a small decrease in IOP that may be useful in early, well-controlled disease. The probability of a clinically significant decrease of greater than or equal to 5 to 6 mm Hg-required for advanced/uncontrolled disease-is low. Results support the role of phacoemulsification in PACG.
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Affiliation(s)
- Ravi Thomas
- From the *Queensland Eye Institute; †University of Queensland, Brisbane, Queensland; ‡Glaucoma Investigation and Research Unit, Royal Victorian Eye & Ear Institute, Melbourne, Victoria; and §Discipline of Mathematical Sciences, Queensland, University of Technology, Brisbane, Queensland, Australia
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Turalba A, Payal AR, Gonzalez-Gonzalez LA, Cakiner-Egilmez T, Chomsky AS, Vollman DE, Baze EF, Lawrence M, Daly MK. Cataract Surgery Outcomes in Glaucomatous Eyes: Results From the Veterans Affairs Ophthalmic Surgery Outcomes Data Project. Am J Ophthalmol 2015. [PMID: 26210863 DOI: 10.1016/j.ajo.2015.07.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To compare visual acuity outcomes, vision-related quality of life, and complications related to cataract surgery in eyes with and without glaucoma. DESIGN Retrospective cohort study. METHODS Cataract surgery outcomes in cases with and without glaucoma from the Veterans Affairs Ophthalmic Surgical Outcomes Data Project were compared. RESULTS We identified 608 glaucoma cases and 4306 controls undergoing planned cataract surgery alone. After adjusting for age, pseudoexfoliation, small pupil, prior ocular surgery, and anterior chamber depth, we found that glaucoma cases were more likely to have posterior capsular tear with vitrectomy (odds ratio [OR] 1.8, P = .03) and sulcus intraocular lens placement (OR 1.65, P = .03) during cataract surgery. Glaucoma cases were more likely to have postoperative inflammation (OR 1.73, P < .0001), prolonged elevated intraocular pressure (OR 2.96, P = .0003), and additional surgery within 30 days (OR 1.92, P = .03). Mean best-corrected visual acuity (BCVA) and Visual Function Questionnaire (VFQ) scores significantly improved after cataract surgery in both groups (P < .0001), but there were larger improvements in BCVA (P = .01) and VFQ composite scores (P < .0001) in the nonglaucoma vs the glaucoma group. A total of 3621 nonglaucoma cases (94.1%) had postoperative BCVA 20/40 or better, compared to 466 glaucoma cases (89.6%) (P = .0003). CONCLUSIONS Eyes with glaucoma are at increased risk for complications and have more modest visual outcomes after cataract surgery compared to eyes without glaucoma. Despite this, glaucoma patients still experience significant improvement in vision-related outcomes after cataract extraction. Further study is needed to explore potential factors that influence cataract surgery outcomes in glaucomatous eyes.
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Siegel MJ, Boling WS, Faridi OS, Gupta CK, Kim C, Boling RC, Citron ME, Siegel MJ, Siegel LI. Combined endoscopic cyclophotocoagulation and phacoemulsificationversusphacoemulsification alone in the treatment of mild to moderate glaucoma. Clin Exp Ophthalmol 2015; 43:531-9. [DOI: 10.1111/ceo.12510] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 02/05/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Michael J Siegel
- Glaucoma Center of Michigan; Southfield Michigan USA
- Kresge Eye Institute; Wayne State University; Detroit Michigan USA
- Department of Ophtalmology; William Beaumont Hospital; Royal Oak Michigan USA
| | - Whitney S Boling
- Glick Eye Institute; Indiana University; Indianapolis Indiana USA
- Boling Vision Center; Elkhart Indiana USA
| | - Omar S Faridi
- Connecticut Eye Physicians and Surgeons, PC.; Milford Connecticut USA
| | - Chirag K Gupta
- Department of Ophtalmology; William Beaumont Hospital; Royal Oak Michigan USA
| | - Chaesik Kim
- Kresge Eye Institute; Wayne State University; Detroit Michigan USA
| | | | - Matthew E Citron
- Glaucoma Center of Michigan; Southfield Michigan USA
- Department of Ophtalmology; William Beaumont Hospital; Royal Oak Michigan USA
- Department of Ophthalmology; St. John Providence Hospital-Michigan State University; Madison Heights Michigan USA
| | - Marc J Siegel
- Glaucoma Center of Michigan; Southfield Michigan USA
- Department of Ophtalmology; William Beaumont Hospital; Royal Oak Michigan USA
| | - Les I Siegel
- Glaucoma Center of Michigan; Southfield Michigan USA
- Department of Ophtalmology; William Beaumont Hospital; Royal Oak Michigan USA
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12
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13
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Lens-based glaucoma surgery: Using cataract surgery to reduce intraocular pressure. J Cataract Refract Surg 2014; 40:1255-62. [DOI: 10.1016/j.jcrs.2014.06.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 01/13/2014] [Indexed: 11/19/2022]
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Netland PA. Cataract surgery in glaucoma patients: how much benefit? Am J Ophthalmol 2014; 157:1-3. [PMID: 24330911 DOI: 10.1016/j.ajo.2013.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Revised: 09/20/2013] [Accepted: 09/21/2013] [Indexed: 10/25/2022]
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Slabaugh MA, Bojikian KD, Moore DB, Chen PP. The effect of phacoemulsification on intraocular pressure in medically controlled open-angle glaucoma patients. Am J Ophthalmol 2014; 157:26-31. [PMID: 24182743 DOI: 10.1016/j.ajo.2013.08.023] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 08/26/2013] [Accepted: 08/28/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate intraocular pressure (IOP) after phacoemulsification in patients with medically controlled open-angle glaucoma (OAG), and examine the association of biometric variables to IOP changes. DESIGN Retrospective case series. METHODS Open-angle glaucoma patients without prior incisional glaucoma surgery undergoing phacoemulsification by a single surgeon between January 1997 and October 2011 were evaluated. Patient charts were reviewed to obtain demographic information, preoperative glaucoma medications, severity and treatment measures, and preoperative and postoperative IOP. RESULTS A total of 157 eyes (157 patients) were included in the study. The average preoperative IOP of 16.3 ± 3.6 mm Hg decreased to 14.5 ± 3.4 mm Hg at 1 year (P < .001). Sixty eyes (38%) required additional medications or laser for IOP control within the first year postoperatively, or had a higher IOP at postoperative year 1 without medication change. Among eyes without postoperative medication changes (n = 102), higher preoperative IOP (P < .001), older age (P = .006), and deeper anterior chamber depth (P = .015) were associated with lower postoperative IOP. CONCLUSIONS Phacoemulsification resulted in a small average decrease in IOP in patients with OAG. A sizeable proportion of medically controlled glaucoma patients with open angles undergoing phacoemulsification experienced an increase in IOP or required more aggressive treatment to control IOP postoperatively.
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Affiliation(s)
- Mark A Slabaugh
- Department of Ophthalmology, University of Washington, Seattle, Washington.
| | - Karine D Bojikian
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Daniel B Moore
- Department of Ophthalmology, University of Washington, Seattle, Washington
| | - Philip P Chen
- Department of Ophthalmology, University of Washington, Seattle, Washington
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Lindfield D, Ritchie RW, Griffiths MFP. 'Phaco-ECP': combined endoscopic cyclophotocoagulation and cataract surgery to augment medical control of glaucoma. BMJ Open 2012; 2:bmjopen-2011-000578. [PMID: 22649172 PMCID: PMC3367146 DOI: 10.1136/bmjopen-2011-000578] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Does phaco-ECP reduce intraocular pressure? Is phaco-ECP safe? DESIGN Retrospective case note review of all patients undergoing phaco-ECP between June 2008 and June 2009. All glaucoma subtypes were included. SETTING Single District General Hospital Ophthalmology Department within the UK. PARTICIPANTS 58 participants case notes reviewed. Mean age 79.0 years (SD ±9.8). INTERVENTIONS All patients received combined cataract surgery and endoscopic cyclophotocoagulation. OUTCOME MEASURES Follow-up was 1 day, 1 week, 1, 3, 6, 12, 18 and 24 months for intraocular pressure (IOP) measurement. Number of medications, visual acuity and presence of complications were also assessed. RESULTS Of the 58 cases performed, 56 case notes (97%) were available for analysis. Mean age 79.0 years (SD ±9.8). Mean pre-procedural IOP was 21.54 mm Hg (95% CI 19.86 to 23.22, n=56). Mean IOP was 14.43 mm Hg (95% CI 13.65 to 15.21, n=53) at 18 months and 14.44 mm Hg (95% CI 13.63 to 15.25, n=41) at 24 months. The mean drop from baseline to 18 and 24 months was 7.1 mm Hg. Statistically significant decrease in IOP was demonstrated at all time points (p<0.001). Mean medication usage was 1.97 agents (95% CI 1.69 to 2.25) at baseline, 1.96 agents (95% CI 1.70 to 2.22) at 18 months and 2.07 agents (95% CI 1.76 to 2.38) at 24 months. No statistically significant change throughout. CONCLUSIONS This study confirms the safety of phaco-ECP. In this case series, the IOP-lowering effect was significant at all time points; however, the effect of cataract surgery alone was not controlled. A randomised controlled trial is required to draw efficacy conclusions. The authors proposed endoscopic cyclophotocoagulation's main role is to optimise control of low-risk glaucoma of low-risk patients at the time of cataract surgery. However, the authors do not propose that phaco-ECP is a substitute for filtration surgery in high-risk eyes or when low target pressures (<14 mm Hg) are indicated.
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Affiliation(s)
- Dan Lindfield
- Department of Ophthalmology, Frimley Park Hospital, Camberley, UK
| | - Robert W Ritchie
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford, UK
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