Combined Cataract-Glaucoma Surgery

Kozobolis, Vassilis; Konstantinidis, Aristeidis; Labiris, Georgios

doi:10.5772/54808

Glaucoma - Basic and Clinical Aspects 2013

DOI: 10.5772/54808

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Combined Cataract-Glaucoma Surgery

Vassilis Kozobolis¹,

Aristeidis Konstantinidis²,

Georgios Labiris³

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Cited by 2 publications

(3 citation statements)

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“…Combined phacoemulsification and trabeculectomy is an alternative surgical procedure in glaucoma patients with significant cataracts. It carries the benefit of improved visual acuity (VA) while avoiding anesthesia related risks, multiple surgeries, and IOP spikes after cataract surgery 12–14. Nevertheless, this procedure may increase postoperative inflammation, resulting in a high bleb failure rate 15,16.…”

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confidence: 99%

“…It carries the benefit of improved visual acuity (VA) while avoiding anesthesia related risks, multiple surgeries, and IOP spikes after cataract surgery. [12][13][14] Nevertheless, this procedure may increase postoperative inflammation, resulting in a high bleb failure rate. 15,16 A literature review showed that trabeculectomy and combined phacotrabeculectomy are effective in lowering IOP for both short-term and long-term follow-ups, with a high success rate in PACG.…”

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confidence: 99%

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Two-Year Outcomes of Trabeculectomy and Phacotrabeculectomy in Primary Open Angle Versus Primary Angle Closure Glaucoma

Winuntamalakul

Chansangpetch

Ratanawongphaibul

et al. 2023

Journal of Glaucoma

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Précis: Phacotrabeculectomy had a significantly lower 24-month failure rate than the isolated trabeculectomy in both the primary open angle glaucoma (POAG) and primary angle closure glaucoma (PACG) patients. The impact of adding phacoemulsification to trabeculectomy was found to be similar between the eyes with POAG and PACG. Purpose:The purpose of this study is to compare the 2-year outcomes of primary mitomycin C-augmented combined phacotrabeculectomy (Phaco+Trab) with isolated trabeculectomy (Trab) in phakic patients with POAG and PACG. Materials and Methods:We retrospectively reviewed primary glaucoma patients who underwent mitomycin C-augmented trabeculectomy and completed 2 years of follow-up. Failure rate, postoperative intraocular pressure (IOP), percentage of IOP reduction, and the number of glaucoma medications at 24 months after surgery were compared between the Phaco+Trab and Trab groups. Results:The study included 146 eyes of 121 patients; 74 underwent Trab and 72 underwent Phaco+Trab. POAG and PACG were present in 71 and 75 eyes, respectively. Defining a failure with IOP criteria of > 18 mm Hg or IOP reduction of <30%, the failure rates were 42% and 62% for Phaco+Trab and Trab, respectively. The Phaco+Trab group had a significantly lower failure rate than the Trab group for all subjects [risk ratio (RR): 0.60, 95% CI, 0.44-0.81, P = 0.001], POAG subgroup (RR: 0.61, 95% CI, 0.41-0.93, P = 0.02), and PACG subgroup (RR: 0.53, 95% CI, 0.33-0.86, P = 0.01). Differences in the postoperative IOP, percentage of IOP reduction, and number of glaucoma medications were not significant between the 2 groups for all subjects, POAG, and PACG (all P > 0.05). The magnitude of the effects of adding phacoemulsification to the trabeculectomy was comparable for the POAG and PACG groups, for each outcome (all P > 0.05). Conclusions:The final 24-month failure rate in the Phaco+Trab group was lower than that in the Trab group in both the POAG and PACG subjects. The impact of adding phacoemulsification to trabeculectomy was found to be similar between the eyes with POAG and PACG.

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mentioning

confidence: 99%

mentioning

confidence: 99%

Two-Year Outcomes of Trabeculectomy and Phacotrabeculectomy in Primary Open Angle Versus Primary Angle Closure Glaucoma

Winuntamalakul

Chansangpetch

Ratanawongphaibul

et al. 2023

Journal of Glaucoma

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“…The ostium of the implant can be blocked by a number of mechanisms, including, but not limited to, iris occlusion, lens fragment material (in the case of combined surgeries), and blood. Several risk factors have been identified to increase the risk of iris occlusion with tube shunts that may apply to implantation of a gel stent, including intraoperative floppy iris syndrome (IFIS), peripheral iris abnormality, low positioning into the angle/iris root (Figure 6), narrow angle, phakic lens status, and previous iridotomy in the vicinity of the implantation (owing to the risk of iris strands incarcerating the internal ostium) 27,28. Iris occlusion of the gel stent implant is a rarely occurring event when proper implant placement is achieved.If any form of obstruction is suspected, clinical factors, such as elevated IOP (with the magnitude of elevation proportional to the level of occlusion), absent or low bleb, and patient complaints of transient discomfort with IOP spikes occurring at nighttime or under low-light conditions, can be used to determine the need for intervention.…”

mentioning

confidence: 99%

Gel Stent Implantation—Recommendations for Preoperative Assessment, Surgical Technique, and Postoperative Management

Vera¹,

Ahmed²,

Stalmans³

et al. 2018

US Ophthalmic Review

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The surgical management of glaucoma offers the potential to lower intraocular pressure (IOP) independent of patients’ compliance with their medication regimen. Procedures such as trabeculectomy and tube shunt placement often yield large magnitudes of IOP reduction, but may be associated with short- and long-term complications. Microinvasive glaucoma surgery (MIGS) offers an alternative surgical approach that is inherently less invasive; however, most devices that fit in this category are associated with a lesser degree of IOP-lowering efficacy compared with traditional glaucoma surgeries. A newer MIGS device, a gel stent that facilitates drainage to the subconjunctival space, appears to offer similar IOP reduction to trabeculectomy, but with much less tissue manipulation; better predictability; and less sight-threatening complications, thus making it a potentially safer and more predictable surgical option in appropriate patients. The following proposed protocol, based on evidence-based practices and augmented where necessary by the opinions of experienced surgeons, provides guidance for the pre-, intra-, and postoperative management of patients receiving a gel stent implant. The goal of this protocol is to provide a framework for better patient selection and preparation, surgical pearls, and how best to assess and manage patients in the postoperative period.

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Combined Cataract-Glaucoma Surgery

Cited by 2 publications

References 106 publications

Two-Year Outcomes of Trabeculectomy and Phacotrabeculectomy in Primary Open Angle Versus Primary Angle Closure Glaucoma

Two-Year Outcomes of Trabeculectomy and Phacotrabeculectomy in Primary Open Angle Versus Primary Angle Closure Glaucoma

Gel Stent Implantation—Recommendations for Preoperative Assessment, Surgical Technique, and Postoperative Management

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