Aim: To compare the long term mean intraocular pressure (IOP) reduction after non-augmented single site phacotrabeculectomy with that after trabeculectomy and to determine the relation between preoperative IOP and IOP reduction. Methods: A group of 44 consecutive patients with chronic open angle glaucoma who underwent phacotrabeculectomy were matched to a trabeculectomy control group and the results of surgery were compared. Linear regression analysis of preoperative IOP and IOP reduction was undertaken.Results: The mean IOP reduction was significantly less in the phacotrabeculectomy group (6.7 (SD 2.1) mm Hg) than in the trabeculectomy group (11.0 (1.4) mm Hg) (p=0.0017). There was a significant difference in surgical success between the groups. The preoperative IOP was significantly related to the postoperative reduction in IOP in both groups (p<0.001). Conclusions: In elderly white patients with chronic open angle glaucoma, phacotrabeculectomy is not as effective as trabeculectomy in reducing IOP. In both procedures the magnitude of IOP reduction is proportional to the preoperative IOP. I n recent years, there has been a widespread shift towards the use of combined phacotrabeculectomy as the surgical treatment of choice for coexisting cataract and glaucoma. 1 Despite its popularity, the efficacy of this operation compared to trabeculectomy remains unclear and published follow up periods are generally short, rarely exceeding a year.2-8 In addition, the relation between the preoperative IOP and IOP reduction after phacotrabeculectomy has not been previously reported.In this retrospective study, the long term efficacy of single site phacotrabeculectomy without intraoperative antimetabolites is compared to that of trabeculectomy in a matched group of patients and the relation between preoperative IOP and the magnitude of IOP reduction is examined.
PATIENTS AND METHODSFrom September 1996 to July 2000, 44 consecutive patients with chronic open angle glaucoma (COAG) at low risk of bleb failure, underwent combined phacotrabeculectomy without antimetabolites by a single surgeon (JFS). The results of surgery were retrospectively analysed. All patients with COAG who underwent trabeculectomy without antimetabolites during the same period by the same surgeon were identified, and 44 were matched to the phacotrabeculectomy group with respect to age, sex, race, and preoperative IOP. All patients were followed for at least 12 months, with an average follow up of 29 (SD 3.4) months in both groups.Phacotrabeculectomy was performed using a fornix based, superior, one site approach. Phacoemulsification was undertaken through a 3.2 mm incision and a foldable three piece silicone IOL was placed into the capsular bag. The scleral tunnel was incised at its lateral borders to create a scleral flap and a punch was used to create an internal sclerectomy. A peripheral iridectomy was then undertaken and the scleral flap and conjunctiva were sutured with 10-0 nylon. Postoperative drops consisted of topical chloramphenicol and dexamethasone...
Submacular haemorrhages seem to be a significant adverse event following intravitreal bevacizumab in large occult choroidal neovascularisation and may affect visual outcomes. Prospective studies are required to establish the optimal dose of bevacizumab for larger lesion sizes or to identify the most appropriate anti-VEGF agent in large occult CNV with fibrovascular and serous PED lesions.
Acute submacular haemorrhages appear to be a significant adverse event following intravitreal bevacizumab in occult CNV > or = 15 mm(2). Intravitreal ranibizumab appears to have a significantly lower incidence of postoperative submacular haemorrhage in occult CNV > or = 15 mm(2). Larger studies are required to identify the most appropriate agent for the treatment of large occult CNV.
Purpose The development of 23-gauge vitrectomy surgery has many benefits including a reduction in surgical time and faster postoperative rehabilitation; however, some have suggested that the complication rate is higher. To assess this we compared the incidence and distribution of iatrogenic retinal tears in 20-and 23-gauge surgery. Methods Fifty consecutive 23-gauge and 50 consecutive 20-gauge vitrectomy cases were selected; eyes with a history of previous vitreoretinal surgery were excluded. All surgery was performed by two surgeons (JL and RN). Entry-site breaks (ESB) were defined as any new vitreoretinal abnormality occurring within 1 clock hour of an entry site for which treatment with cryotherapy was deemed necessary. Data were collected by retrospective case note review. Statistical analysis was carried out using Fisher's exact and v 2 -tests. Results ESB occurred in 24% (12/50) of cases in the 20-gauge group compared with 8% (4/50) in the 23-gauge group (P ¼ 0.03); 88% (14/16) occurred superiorly on the same side as the surgeons' dominant hand. Iatrogenic breaks recorded elsewhere indicated an increased incidence in the 20-gauge group (9/50 compared with 6/50 in 23-gauge) but this did not achieve significance; the most common position was at 6 o'clock. Conclusions 23-Gauge vitrectomy is associated with significantly fewer ESB when compared with conventional 20-gauge vitrectomy. The incidence of other iatrogenic breaks did not appear to be significantly different between the two groups.
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