Long-term effect of phacoemulsification on trabeculectomy function

Abstract

Purpose To investigate the long-term effect of phacoemulsification on intraocular pressure (IOP) in trabeculectomized eyes and to identify the factors affecting the IOP changes. Methods In consecutive patients with previous trabeculectomy (TE) who underwent uncomplicated clear cornea phacoemulsification we evaluated intraocular pressure, need of antiglaucomatous medical therapy or glaucoma surgery, and length of glaucoma control without therapy. Glaucoma therapy was prescribed in the presence of IOP 418 mm Hg or worsening of the visual field. A group of trabeculectomized eyes that did not receive cataract surgery was retrospectively selected as a control. Multivariate analysis was used to test factors related to final outcome of the treatment. Results One hundred and eight eyes with previous TE that received phacoemulsification and 108 controls were included in the study. Phacoemulsification was performed 60 ± 21 months after TE. After a mean follow-up of 66 ± 28 months, mean IOP was significantly increased in the cataract surgery group (by 1.7 ± 4.3 mm Hg) and in the control group (by 2.3 ± 4.3 mm Hg)(both Po0.001); in two groups, respectively, 31 eyes (28.7%) and 17 eyes (15.7%) had received glaucoma therapy (chi-square P = 0.030). Factors related to success (no need of therapy) were use of mitomycin-C (MMC) in previous TE (Po0.001), longer time from TE to cataract surgery (P = 0.007), higher preoperative bleb score (P = 0.021), and lower baseline IOP (P = 0.042). Conclusions Cataract surgery reduces the function of filtering bleb in some eyes. Factors related to low rate of failure are the previous use of MMC during TE, longer time from TE to cataract surgery, and good preoperative aspect of the bleb.

Primary Open-Angle Glaucoma Preferred Practice Pattern® Guidelines

“…[448][449][450] Potential benefits of a combined procedure (cataract extraction with IOL implantation and trabeculectomy) are protection against the IOP rise that may complicate cataract surgery alone, the possibility of achieving long-term glaucoma control with a single operation, and elimination of the risk of bleb failure with subsequent cataract surgery when glaucoma surgery is performed first. [451][452][453] Therefore, an ophthalmologist may reasonably choose to perform a combined surgery because of these perceived advantages to an individual patient.…”

Outcomes of viscocanalostomy and phaco-viscocanalostomy in patients with advanced glaucoma

“…In comparison, only 5% patients in our group required cataract surgery in the study period. Cataract surgery can decrease the success of a trabeculectomy with an increased likelihood of post-operative interventions and requirement for glaucoma medication in 30–39% cases [ 20 , 21 ]. These risks are avoided with VC due to its bleb-independent mechanism of action.…”

Outcome of phacoemulsification in patients with open-angle glaucoma after selective laser trabeculoplasty

“…Mierzejewski et al demonstrated the highest reduction of postoperative IOP which is 4 mmHg after phacoemulsification in eyes with POAG, however pseudoexfoliative glaucoma was included, and because no specific gonioscopic grading was shown, eyes with narrow angle before phacoemulsification can clarify the substantial reduction in postoperative IOP after surgery [25]. Other studies included eyes with normal tension glaucoma (NTG) or medically uncontrolled POAG [26,27]. These methodological variations possibly account for the high variability in the outcomes.…”