Surgical outcome of safe surgery system trabeculectomy combined with cataract extraction

Abstract

Purpose To determine the efficacy of safe surgery system trabeculectomy combined with manual small incision cataract surgery/ phacoemulsification in primary glaucoma coexistent with cataract. Methods This is a retrospective analysis of 105 cases who underwent single-site combined surgery between January 2008 and December 2009. Safe surgery system trabeculectomy with diffuse and posterior application of mitomycin C was performed in all cases. Cataract extraction was done either by Manual Small Incision Cataract Surgery (MSICS) or phacoemulsification. Main outcome measures were success rate of trabeculectomy, as determined by four different IOP goals and incidence of postoperative complications. Analysis was performed using R-2.15, and the significance was tested at 5% level. Results The minimum follow-up period was 12 months. The overall success rates (with or without medication) when safe surgery system trabeculectomy was combined with MSICS were 91, 70, and 51% for IOP r18, r15, and r12 mm Hg, respectively, and target IOP was achieved in 72% cases. The mean IOP reduction was 43.8% with MSICS and 42.08% with phacoemulsification. The surgical outcome was not significantly different for both techniques. Postoperative complications were infrequent and comparable. Conclusion The Safe Surgery System Trabeculectomy combined with cataract surgery offers excellent IOP control with minimal postoperative complications. It offers an effective and improved solution for primary glaucoma coexistent with cataract found in developing countries.

<p>Evaluating the efficacy of short duration Mitomycin C in safe surgery system trabeculectomy combined with cataract surgery</p>

“…For IOP ≤21 mmHg, the overall success was 80.5% in the study group and 90.9% for the control group, similar to earlier studies 14,22–24. However when more stringent criteria of IOP ≤18 mmHg, was used, it was found that the overall success was only 36.6% for the study group and 68.2% for the control group.…”

“…The IOP reduction was 31.3% in the study group (1-minute), as compared to 43.3% in the control group (2-minutes). Mittal et al14 found a mean IOP reduction of 31% in a retrospective analysis of combined surgery cases using MMC for 2 minutes, and Khandelwal et al 24 found a 40% reduction with MMC for 2 minutes in combined surgery cases after 12 months follow-up.…”

“…With the higher concentration and long duration of MMC application, the IOP lowering effect was better, but the risk of long-term complications increased. To minimize MMC-related complications, safe surgery system trabeculectomy was developed by Khaw et al, 19 which could be combined with cataract extraction (phacoemulsification/MSICS) with good surgical outcome 24…”

Efficacy and Safety of Manual Small-Incision Cataract Surgery With Trabeculectomy Versus Phacotrabeculectomy in Patients With Glaucoma and Cataract: A Systematic Review and Meta-Analysis

“…We reviewed seven retrospective studies comparing (a) Manual small-incision cataract surgery with trabeculectomy (n = 352 eyes) and (b) Phacoemulsification with trabeculectomy (n = 348) eyes [12][13][14][15][16][17][18]. No prospective studies were found from the study selection process.…”

Operieren wir die Glaukome zu spät?

“…Die während der Kataraktoperation durchgeführte Gabe von 5-Fluorouracil subkonjunktival kann zwar das Risiko der Druckentgleisung mindern, aber nicht ganz verhindern [44,45]. Aus diesem Grunde gibt es auch gute Argumente, zusammen mit der filtrierenden Operation auch gleichzeitig eine Kataraktoperation durchzuführen, insbesondere wenn schon eine beginnende Katarakt vorhanden ist, deren rasche Progression nach einer alleinigen filtrierende Operation quasi sicher ist [46][47][48]. Das Hauptargument, dass die kombinierten Katarakt-/Glaukomoperationen bez.…”