Long-term intraocular pressure control after cataract extraction with trabeculectomy: Phacoemulsification versus extracapsular technique

Kosmin, Alan; Wishart, P K; Ridges, Peter J.G.

doi:10.1016/s0886-3350(98)80207-1

Cited by 33 publications

(9 citation statements)

References 19 publications

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“…In addition to steroid induced glaucoma, pseudoexfoliation glaucoma confers a larger IOP reduction in the present study. Although phacoemulsification was negatively correlated with IOP reduction in this analysis, something that has been described for combined traditional trabeculectomy 18, 19 , it is important to recall that this study was not designed to formally compare outcomes of combined versus trabectome-alone as we have done before 9 . The number of patients analyzed here is significantly higher than in the two separate studies but we note similar results in the regression analysis allowing to discover additional factors.…”

Section: Discussionmentioning

confidence: 91%

Combined analysis of trabectome and phaco-trabectome outcomes by glaucoma severity

et al. 2016

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Prior glaucoma severity staging systems were mostly concerned with visual field function and retinal nerve fiber layer, but did not include intraocular pressure or medications to capture resistance to treatment. We recently introduced a simple index that combines pressure, medications, and visual field damage and applied it to stratify outcomes of trabectome surgery. This microincisional glaucoma surgery removes the primary resistance to outflow in glaucoma, the trabecular meshwork, and has been mostly used in mild glaucoma. Traditional glaucoma surgeries have a relatively high complication rate and have been reserved for more advanced disease stages. In the analysis presented here we include our data of trabectome combined with cataract surgery. This is a common practice pattern as both occur in the same age group with increasing frequency. For patients in higher glaucoma index (GI) groups, the intraocular pressure (IOP) reduction was 2.34+/-0.19 mmHg more than those in a GI group one level lower while holding everything else constant. Those who had undergone trabectome combined with phacoemulsification had an IOP reduction that was 1.29+/-0.39 mmHg less compared to those with trabectome alone. No statistically significant difference was found between genders and age groups while holding everything else constant. Hispanics had a 3.81+/-1.08 mmHg greater IOP reduction. Pseudoexfoliation and steroid glaucoma patients had an IOP reduction that was greater by 2.91+/-0.56 and 3.86+/-0.81 mmHg, respectively, than those with primary open angle glaucoma. These results suggest a role for trabectome-mediated ab interno trabeculectomy beyond mild forms of glaucoma. Additionally, the multifactorial glaucoma index demonstrates a role in staging patients when comparing glaucoma surgical modalities.

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Section: Discussionmentioning

confidence: 91%

Combined analysis of trabectome and phaco-trabectome outcomes by glaucoma severity

et al. 2016

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“…25 Although long-term studies of phacotrabeculectomy with MMC report a mean pressure drop of 34% (to a mean IOP of 15 mm Hg) with MMC 2,26 and a pressure drop of 25% to 16 mm Hg with 5-fluorouracil, 27 these pressure levels were only achieved with the addition of a mean 1.0 medication per eye. We achieved a mean 33.2% pressure drop to a mean IOP of 16 mm Hg with virtually no medications (0.1 G 0.5).…”

Section: Discussionmentioning

confidence: 99%

Seven-year follow-up of combined cataract extraction and viscocanalostomy

Wishart

Dagres

2006

Journal of Cataract and Refractive Surgery

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“…1 Despite its popularity, the efficacy of this operation compared to trabeculectomy remains unclear and published follow up periods are generally short, rarely exceeding a year. [2][3][4][5][6][7][8] In addition, the relation between the preoperative IOP and IOP reduction after phacotrabeculectomy has not been previously reported.…”

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confidence: 98%

Long term effect on intraocular pressure of phacotrabeculectomy compared to trabeculectomy

Lochhead¹,

Casson²,

Salmon³

2003

British Journal of Ophthalmology

110

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Aim: To compare the long term mean intraocular pressure (IOP) reduction after non-augmented single site phacotrabeculectomy with that after trabeculectomy and to determine the relation between preoperative IOP and IOP reduction. Methods: A group of 44 consecutive patients with chronic open angle glaucoma who underwent phacotrabeculectomy were matched to a trabeculectomy control group and the results of surgery were compared. Linear regression analysis of preoperative IOP and IOP reduction was undertaken.Results: The mean IOP reduction was significantly less in the phacotrabeculectomy group (6.7 (SD 2.1) mm Hg) than in the trabeculectomy group (11.0 (1.4) mm Hg) (p=0.0017). There was a significant difference in surgical success between the groups. The preoperative IOP was significantly related to the postoperative reduction in IOP in both groups (p<0.001). Conclusions: In elderly white patients with chronic open angle glaucoma, phacotrabeculectomy is not as effective as trabeculectomy in reducing IOP. In both procedures the magnitude of IOP reduction is proportional to the preoperative IOP. I n recent years, there has been a widespread shift towards the use of combined phacotrabeculectomy as the surgical treatment of choice for coexisting cataract and glaucoma. 1 Despite its popularity, the efficacy of this operation compared to trabeculectomy remains unclear and published follow up periods are generally short, rarely exceeding a year.2-8 In addition, the relation between the preoperative IOP and IOP reduction after phacotrabeculectomy has not been previously reported.In this retrospective study, the long term efficacy of single site phacotrabeculectomy without intraoperative antimetabolites is compared to that of trabeculectomy in a matched group of patients and the relation between preoperative IOP and the magnitude of IOP reduction is examined. PATIENTS AND METHODSFrom September 1996 to July 2000, 44 consecutive patients with chronic open angle glaucoma (COAG) at low risk of bleb failure, underwent combined phacotrabeculectomy without antimetabolites by a single surgeon (JFS). The results of surgery were retrospectively analysed. All patients with COAG who underwent trabeculectomy without antimetabolites during the same period by the same surgeon were identified, and 44 were matched to the phacotrabeculectomy group with respect to age, sex, race, and preoperative IOP. All patients were followed for at least 12 months, with an average follow up of 29 (SD 3.4) months in both groups.Phacotrabeculectomy was performed using a fornix based, superior, one site approach. Phacoemulsification was undertaken through a 3.2 mm incision and a foldable three piece silicone IOL was placed into the capsular bag. The scleral tunnel was incised at its lateral borders to create a scleral flap and a punch was used to create an internal sclerectomy. A peripheral iridectomy was then undertaken and the scleral flap and conjunctiva were sutured with 10-0 nylon. Postoperative drops consisted of topical chloramphenicol and dexamethasone...

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Long-term intraocular pressure control after cataract extraction with trabeculectomy: Phacoemulsification versus extracapsular technique

Cited by 33 publications

References 19 publications

Combined analysis of trabectome and phaco-trabectome outcomes by glaucoma severity

Combined analysis of trabectome and phaco-trabectome outcomes by glaucoma severity

Seven-year follow-up of combined cataract extraction and viscocanalostomy

Long term effect on intraocular pressure of phacotrabeculectomy compared to trabeculectomy

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