Effect of Prior Phacoemulsification Surgery in Trabeculectomy Surgery Outcomes

Abstract

To evaluate whether previous clear-cornea phacoemulsification surgery affects the surgical outcomes of trabeculectomy in open-angle glaucoma (OAG). Methods: We performed a retrospective cohort study, which included 82 patients with OAG that underwent trabeculectomy between January 1, 2010, and December 31, 2017. The primary outcome was the probability of surgical failure. Failure was defined as IOP >21 mmHg or reduced <20% from baseline, IOP ≤5 mmHg in three consecutive visits, need for further glaucoma surgery, phthisis or loss of light perception vision due to glaucoma. Results: Eighty-two eyes (58 phakic and 24 pseudophakic) were included. Phakic group patients were younger than those in the pseudophakic group, 65.8 ± 11.7 vs 76.2 ± 7.9 years (p < 0.001). The most common type of glaucoma was primary OAG [59% (n = 34) phakic vs 63% (n = 15) pseudophakic], followed by exfoliative and pigmentary glaucomas. The mean preoperative IOP was not significantly different between groups nor was the number of preoperative hypotensive medications. The rate of surgical failure was not significantly different between groups at year 1 [17% (n = 10) phakic vs 29% (n = 7) pseudophakic; p = 0.361] nor at year 2 [28% (n = 16) phakic vs 46% (n = 11) pseudophakic; p = 0.110]. No significant differences were observed regarding the postoperative IOP or any secondary outcome measures at year 1 or 2. Conclusion: Previous clear-cornea phacoemulsification surgery does not lead to statistically significant differences in the rate of trabeculectomy failure. Despite not being significant, clinically relevant differences were observed between groups. Future studies with a larger sample and/or randomized are needed to clarify this association.

Outcome of Trabeculectomy in Phakic and Pseudophakic Eyes with Open Angle Glaucoma after Phacoemulsification: A retrospective Comparative Study

“…The current study results differ than that reported by Torres-Costa et al [18] who could not find significant difference between phakic and pseudophakic eyes, regarding failure rate after trabeculectomy for OAG. Another study by Supawavej et al [7] retrospectively evaluated the success rate of trabeculectomy in 39 phakic and 39 pseudophakic eyes.…”

“…In the current study, choroidal detachment reported in excess in pseudophakic eyes, but with insignificant difference than phakic group. These results are in line to that reported by Torres-Costa et al [18] who reported comparable results, where choroidal detachment was reported among 20.8% and 10.3% of pseudophakic and phakic eyes, respectively. Takihara et al [8] also observed more frequency choroidal detachment in pseudophakic eyes than phakic eyes [36% 15%, respectively, p = 0.06].…”

“…Unfortunately, we assessed the short-term success rate [at 6 months] and could not extend the evaluation beyond this duration due to higher drop rate of patient's follow up One possible explanation for such controversy is the different age groups between phakic and pseudophakic eyes. For example, Torres-Costa et al [18] believe that, younger patients are prone to more risk of trabeculectomy failure. The age of pseudophakic group, in their study, were significantly older than phakic group, and as the younger age is associated with more trabeculectomy failure, this could be responsible for the insignificant difference between both groups reported in their study.…”

Risk factors for Ex-Press® surgery failure

“…The cause was attributed to the cytokine MCP-1 (monocyte chemotactic protein-1) that increased after cataract surgery [24]. There are also some reports that there was no difference in surgical outcomes between Trab alone and Trab with simultaneous cataract surgery [25][26][27]. Regarding EXP surgery, there are some reports that surgical outcomes were not signi cantly different between Trab alone and Trab with simultaneous cataract surgery.…”

The comparison of efficiency and safety profile of anti-glaucoma surgeries: Trabeculectomy vs. Ex-PRESS implant – a retrospective analysis

“…Then we compared the outcomes with the results of anti-glaucoma procedures in pseudophakic eyes. There have already been studies that include the comparison for Ex-PRESS implantation [5][6][7] and trabeculectomy [8][9][10][11][12][13][14], however they focus on these procedures separately. There is also a publication concentrating on comparing trabeculectomy combined with phacoemulsification versus Ex-PRESS implantation with phacoemulsification [15], however it proved to be inconclu-…”