Effect of technique on intraocular pressure after combined cataract and glaucoma surgery

Jampel, Henry D.; Friedman, David S.; Lubomski, Lisa H.; Kempen, John H.; Quigley, Harry A.; Congdon, Nathan; Levkovitch-Verbin, Hani; Robinson, Karen A.; Bass, Eric B.

doi:10.1016/s0161-6420(02)01439-2

Cited by 102 publications

(79 citation statements)

References 33 publications

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“…An earlier literature review suggested that there is an insufficient evidence to conclude whether staged or combined procedures give better pressure control in glaucoma. 6 Cataract surgery alone has been reported to produce a small reduction in IOP even in advanced glaucoma, 7 but the mean drop was only 4 mm Hg and most patients were still on topical medication post-operatively, suggesting it to be an inadequate procedure for our population. Our results in terms of IOP control were similar to our earlier report of simple trabeculectomy 2 (which achieved 73% (CI 66-80%) post-operative IOPs of 15 mm Hg or less and 90% (CI 85-95%) 21 mm Hg or less, mean follow-up 8 months).…”

Section: Discussionmentioning

confidence: 81%

Combined cataract and trabeculectomy surgery for advanced glaucoma in East Africa; visual and intra-ocular pressure outcomes

Bowman

Hay

Wood³

et al. 2009

Eye

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Aim To investigate visual and intra-ocular pressure (IOP) outcomes of combined cataract and glaucoma surgery at a high-volume centre in East Africa carried out over a 1-year period (2006). Methods A retrospective analysis of patient records. Results A total of 163 patients were identified. Mean age was 67 years (SD 11, range 21-86 years) and 113 (69%) were men. Presenting visual acuity in the operated eye was 6/60 or worse in 135/163 (93%) and was o3/60 in 76 of 163 (47%) patients. Mean presenting IOP was 28 mm Hg (SD 9, range 12-60). Pre-operative cup disc ratios were 0.8 or worse in 131 of 163 (85%) patients. Phacotrabeculectomy (PT) was carried out in 130 (80%) cases, small incision cataract surgery trabeculectomy (SICST) in 10 (6.1%) cases, and extra-capsular cataract extraction trabeculectomy (ECCET) in 23 (14.1%) cases. In all, 107 (66%) attended for follow-up (mean interval 104 days, range: 6-390 years, SD 88) and at follow-up 75 (70%) patients had improved visual acuity pre-operatively. Pre-operative cup disc ratio of 0.9 or greater predicted failure to improve VA at follow-up (OR 4.0 95% confidence interval (CI) 1.30-12.1). Fifty-nine (62% (95%CI 52-71%)) patients had follow-up IOPs of 6-15 mm Hg and 82 (85% (95% CI 78-92%)) had follow-up IOPs of 6-20 mm Hg. Conclusion Combined surgery produces visual benefit for most patients with similar pressure control to pure trabeculectomy and is therefore a useful option in practises where follow-up may be doubtful.

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Section: Discussionmentioning

confidence: 81%

Combined cataract and trabeculectomy surgery for advanced glaucoma in East Africa; visual and intra-ocular pressure outcomes

Bowman

Hay

Wood³

et al. 2009

Eye

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“…[1][2][3][4][5][6][7][8][9][10] In various studies, adjunctive mitomycin-C (MMC) has been demonstrated to increase the success rate of trabeculectomy when compared with trabeculectomy alone or with postoperative 5-fluorouracil injections. 1,2,[11][12][13] Unfortunately, antimetabolite-augmented glaucoma surgery can be associated with a higher frequency of prolonged wound leaks, hypotony with choroidal effusions and maculopathy, thin avascular blebs, and/or bleb leaks with late infection. 9,14,15 Recently, a new biodegradable porous collagen-glycosaminoglycan (GAG) copolymer matrix implant has been proposed for glaucoma surgery on the basis of animal experiments.…”

Section: Introductionmentioning

confidence: 99%

Biodegradable collagen matrix implant vs mitomycin-C as an adjuvant in trabeculectomy: a 24-month, randomized clinical trial

Cillino

Pace

Cillino

et al. 2011

Eye

106

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Aim To verify the safety and efficacy of Ologen (OLO) implant as adjuvant compared with low-dosage mitomycin-C (MMC) in trabeculectomy. Methods This was a prospective randomized clinical trial with a 24-month follow-up. Forty glaucoma patients (40 eyes) were assigned to trabeculectomy with MMC or OLO. Primary outcome includes target IOP at r21, r17, and r15 mm Hg; complete (target IOP without medications), and qualified success (target IOP regardless of medications). Secondary outcomes include bleb evaluation, according to Moorfields Bleb Grading System (MBGS); spectral domain optical coherence tomography (SD-OCT) examination; number of glaucoma medications; and frequency of postoperative adjunctive procedures and complications. Results The mean preoperative IOP was 26.5 ( ± 5.2) in MMC and 27.3 ( ± 6.0) in OLO eyes, without statistical significance. One-day postoperatively, the IOP dropped to 5.2 ( ± 3.5) and 9.2 ( ± 5.5) mm Hg, respectively (P ¼ 0.009). The IOP reduction was significant at end point in all groups (P ¼ 0.01), with a mean IOP of 16.0 (±2.9) and 16.5 (±2.1) mm Hg in MMC and OLO, respectively. The rates and Kaplan-Meier curves did not differ for both complete and qualified success at any target IOP. The bleb height in OLO group was higher than MMC one (Po0.05). SD-OCT analysis of successful/ unsuccessful bleb in patients with or without complete success at IOP r17 mm Hg indicated a sensitivity of 83% and 73% and a specificity of 75% and 67%, respectively, for MMC and OLO groups. No adverse reaction to OLO was noted. Conclusions Our results suggest that OLO implant could be a new, safe, and effective alternative to MMC, with similar long-term success rate.

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“…Evidence-based data indicate that the use of mytomicin-C (MMC) during trabeculectomy has a significant positive effect on postoperative intraocular pressure (IOP) (Jampel et al 2002;Wilkins et al 2005). In our experience, MMC can be regarded as an enhancement of the deep sclerectomy IOP-lowering effect without evidence of antimetabolite-related complications (Cillino et al 2005).…”

Section: Introductionmentioning

confidence: 99%

E-PTFE (Gore-Tex^®) implant with or without low-dosage mitomycin-C as an adjuvant in penetrating glaucoma surgery: 2 year randomized clinical trial

Cillino

Zeppa

Pace

et al. 2008

Acta Ophthalmologica

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ABSTRACT.Purpose: To test the expanded polytetrafluoroethylene (ePTFE) as a new adjuvant in trabeculectomy. Methods: Consecutive glaucoma surgical inpatients were observed at the Department of Ophthalmology of Palermo University. Sixty patients (60 eyes) were randomly assigned to undergo trabeculectomy (T), trabeculectomy with mitomycin-C (TMMC), with ePTFE (TG) or with mitomycin-C and ePTFE (TGMMC). Postoperative visits were scheduled at 24 hr, 7 days, 1, 3, 6, 12, 18 and 24 months. Complete success and qualified success were assessed at two target intraocular pressure (IOP) levels -£21 and £17 mmHg -by Kaplan-Meier curves. Results: The postoperative IOP reduction was significant (P < 0.01) at the endpoint in all groups, with a mean IOP of 16.9 (±2.9), 16.2 (±2.7), 15.3 (±3.4) and 15.2 (±4.3) mmHg in T, TMMC, TG and TGMMC eyes, respectively. No intergroup difference was found at either IOP targets. The Kaplan-Meier curves relating to either the £21 mmHg or the £17 mmHg target IOP did not show significant intergroup differences for complete and qualified success rate. When ePTFE was used, a trend favouring the medium-term survival rate was noted. No adverse reaction to the ePTFE was present, and no membrane extrusion or conjuctival erosion were noted in any cases. Hypotony was significantly more frequent (P = 0.035) in groups without ePTFE. Moreover, the late MMC-related complications were more frequent when MMC was applied. Conclusion: Expanded polytetrafluoroethylene implant in trabeculectomy is well tolerated and could act as a filtration modulating device. Therefore, it is useful in reducing early hypotony-related complications and contributes to attaining medium-term IOP control that is comparable to the low-dosage MMC.

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Effect of technique on intraocular pressure after combined cataract and glaucoma surgery

Cited by 102 publications

References 33 publications

Combined cataract and trabeculectomy surgery for advanced glaucoma in East Africa; visual and intra-ocular pressure outcomes

Combined cataract and trabeculectomy surgery for advanced glaucoma in East Africa; visual and intra-ocular pressure outcomes

Biodegradable collagen matrix implant vs mitomycin-C as an adjuvant in trabeculectomy: a 24-month, randomized clinical trial

E-PTFE (Gore-Tex^®) implant with or without low-dosage mitomycin-C as an adjuvant in penetrating glaucoma surgery: 2 year randomized clinical trial

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Effect of technique on intraocular pressure after combined cataract and glaucoma surgery

Cited by 102 publications

References 33 publications

Combined cataract and trabeculectomy surgery for advanced glaucoma in East Africa; visual and intra-ocular pressure outcomes

Combined cataract and trabeculectomy surgery for advanced glaucoma in East Africa; visual and intra-ocular pressure outcomes

Biodegradable collagen matrix implant vs mitomycin-C as an adjuvant in trabeculectomy: a 24-month, randomized clinical trial

E-PTFE (Gore-Tex®) implant with or without low-dosage mitomycin-C as an adjuvant in penetrating glaucoma surgery: 2 year randomized clinical trial

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Product

Resources

About

E-PTFE (Gore-Tex^®) implant with or without low-dosage mitomycin-C as an adjuvant in penetrating glaucoma surgery: 2 year randomized clinical trial