Intraocular Pressure Control after Trabeculectomy, Phacotrabeculectomy and Phacoemulsification in a Hispanic Population

Abstract

Purpose: To compare the efficacy of different surgical strategies for intraocular pressure (IOP) control in Hispanic glaucoma patients with and without visually significant cataracts.Design: Comparative retrospective consecutive case series.Methods: The charts of 153 consecutive patients with primary open angle glaucoma who underwent either trabeculectomy alone (n = 51), phacotrabeculectomy (n = 51), or phacoemulsification alone (n = 51) were reviewed to compare IOP control, the number of glaucoma medications required postoperatively, and the inci dence of surgical complications.Results: Preoperative IOP was 17.5 ± 5.2 mm Hg in the trabe-culectomy group, 15.4 ± 4.5 mm Hg in the phacotrabeculectomy group and 13.9 ± 2.9 mm Hg in the phacoemulsification group (p < 0.001 for all comparisons). Mean IOP reduction from baseline was 4.2 ± 6.9 (24.6%) for the trabeculectomy group, 2.9 ± 5.0 (20.8%) for the phacotrabeculectomy group, and 0.9 ± 3.4 (6.5%) for the phacoemulsification group (p = 0.009). The number of IOP-lowering medications required postoperatively decreased significantly in all three groups (p = 0.001). The rate of early and late postoperative complications was similar between the trabeculectomy and phacotrabeculectomy groups and less for the phacoemulsification group.Conclusion: Trabeculectomy and phacotrabeculectomy are both viable surgical options for managing open angle glau coma. Both resulted in similar rates of success, IOP reduction, decrease in use of IOP-lowering medications and post operative complication rates. Phacoemulsification alone had a lower success rate and greater need for postoperative IOP-lowering medications compared to trabeculectomy alone or phacotrabeculectomy. Phacoemulsification alone may be a reasonable option for patients with visually significant cataract and lower baseline IOP.How to cite this article: Jung JL, Isida-Llerandi CG, Lazcano-Gomez G, SooHoo JR, Kahook MY. Intraocular Pressure Control after Trabeculectomy, Phacotrabeculectomy and Phaco-emulsification in a Hispanic Population. J Curr Glaucoma Pract 2014;8(2):67-74.

Two-year results of a multicenter study of the ab interno gelatin implant in medically uncontrolled primary open-angle glaucoma

“…Similarly, the mean number of IOP-lowering medications used at 24 months was not statistically significantly different between treatment groups [30], suggesting limited long-term effectiveness of the device. We did not expect to see additional IOP lowering in the phaco + implant group, because many studies looking at trabeculectomy and phaco-trabeculectomy have shown comparable IOP lowering with both procedures [31][32][33][34][35][36][37][38]. Both phacoemulsification and trabeculectomy techniques have evolved, which might explain why more recent papers report no differences in outcomes between trabeculectomy alone vs combined with phacoemulsification.…”

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“…However, fibrosis in the eye may restrict vision or interfere with drainage of aqueous humor and hence might be fatal [104]. Trabeculectomy surgery is considered an option to release the increased ocular pressure [105]. The main purpose of trabeculectomy is to generate a drainage outflow track for the aqueous humor [105].…”

“…Trabeculectomy surgery is considered an option to release the increased ocular pressure [105]. The main purpose of trabeculectomy is to generate a drainage outflow track for the aqueous humor [105]. Scar formation around the outflow track halts drainage, indicating surgical failure.…”

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“… 6 The Registry in Glaucoma Outcomes Research (RiGOR) study, no ethnicity-based differences were observed in responses to medical, laser, or surgical interventions for glaucoma. 7 An uncontrolled series of Latinos with glaucoma undergoing phacoemulsification, trabeculectomy, or phacotrabeculectomy demonstrated intraocular pressure (IOP) and IOP-lowering medication reductions consistent with those reported in white patients, 8 while several other studies have found Latino ethnicity to be a risk factor for surgical success following trabeculectomy 9 , 10 and tube-shunt implantation. 11 Regarding minimally invasive glaucoma surgeries, a series of Latinos undergoing combined phacoemulsification and trabecular microbypass implantation manifested IOP and medication reductions consistent with those reported in studies with primarily white patient samples, 12 and Latino ethnicity was a positive prognostic factor for success of trabecular ablation.…”