The effect of combined phacotrabeculectomy, trabeculectomy and phacoemulsification on the corneal endothelium in the early stage: a preliminary study

Demir, Atila Gokce; Olgun, Ali; Güven, Dilek; Demir, Mehmet; Sendul, Selam Yekta; Acar, Ozge Pinar Akarsu; Kacar, Hakan

doi:10.1007/s10792-018-1044-6

Cited by 11 publications

(11 citation statements)

References 36 publications

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“…In our previous study, we had found a decrease of 24.85% [14]. Other authors have documented decreases of only 7-16% after one-step phacotrabeculectomy [12,17,18,27,28], but some reported 20-24% decreases [29] closer to ours. We use a two-site approach that may cause more endothelial cell loss than the one site [11,17].…”

Section: Discussionsupporting

confidence: 85%

“…We did not find significant changes of this percentage after one-step phacotrabeculectomy or after trabeculectomy, but we found a significant decrease after two-step phacotrabeculectomy. Our previous study [ 14 ] and other studies have not found significant decreases of this percentage after trabeculectomy [ 10 , 11 ] or after phacotrabeculectomy [ 11 , 28 ].…”

Section: Discussionmentioning

confidence: 79%

“…In the two-step group, CECD decreased non-significantly (3.2%) after trabeculectomy. Other studies have reported CECD decreases between 2 and 10% [ 7 , 8 , 10 , 11 , 14 , 28 , 29 ], and it may be higher with mitomycin C application [ 13 , 15 , 16 , 30 ]. In our previous study, we had documented a non-significant loss (6.35%), but neither in this nor in the previous study did we use mitomycin C.…”

Section: Discussionmentioning

confidence: 99%

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Corneal endothelial cell loss after trabeculectomy and phacoemulsification in one or two steps: a prospective study

Soro-Martínez

Imperial-Ollero

Pastor-Montoro

et al. 2021

Eye

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Objective The objective of this study was to analyse the results of the surgical treatment of coexisting cataract and glaucoma and its effects on corneal endothelial cell density (CECD). Methods We include two longitudinal prospective studies: one randomised that included 40 eyes with open angle glaucoma that received one- (n = 20) or two-step (n = 20) phacotrabeculectomy and another that included 20 eyes that received phacoemulsification. We assess the impact of surgery on different clinical variables and in particular in CECD using Confoscan 4™ confocal microscopy and semiautomatic counting methods. Results Phacoemulsification and phacotrabeculectomy, but not trabeculectomy, increase significantly best-corrected visual acuity and anterior chamber depth and trabeculectomy and one- or two-step phacotrabeculectomy decreased similarly the intraocular pressure. We document percentages of endothelial cell loss of 3.1%, 17.9%, 31.6% and 42.6% after trabeculectomy, phacoemulsification and one- or two-step phacotrabeculectomy, respectively. The coefficient of variation did not increase significantly after surgery but the percentage of hexagonality decreased significantly after phacoemulsification and after two-step phacotrabeculectomy. Conclusions Trabeculectomy, phacoemulsification and phacotrabeculectomy are surgical techniques that cause morphological changes and decrease the densities of the corneal endothelial cells. Trabeculectomy produces lesser endothelial cell loss than phacoemulsification, and phacoemulsification lesser cell loss than phacotrabeculectomy. Two-step phacotrabeculectomy (trabeculectomy followed 3 months later by phacoemulsification) causes more cell loss than one-step phacotrabeculectomy, and this could be due to the cumulative effects of two separate surgical traumas or to a negative conditioning lesion effect of the first surgery. For the treatment of coexisting glaucoma and cataract, one-step phacotrabeculectomy is the treatment of choice.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

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Corneal endothelial cell loss after trabeculectomy and phacoemulsification in one or two steps: a prospective study

Soro-Martínez

Imperial-Ollero

Pastor-Montoro

et al. 2021

Eye

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“…Five studies reported logMAR visual acuity at any follow-up time in a manner that could be included in a meta-analysis. One study was based on patients with POAG [ 35 ], and the four other studies were based on a mixed glaucoma group [ 38 , 40 , 48 , 55 ]. All studies used a combination of some patients receiving antimetabolites and others not receiving antimetabolites during glaucoma surgery.…”

Section: Resultsmentioning

confidence: 99%

“…The need for needling or revision in the intervention groups was reported by nine studies [ 37 , 40 , 41 , 45 , 46 , 48 , 50 , 52 , 54 ]. Visual acuity was reported by five studies [ 35 , 38 , 40 , 48 , 55 ]. Furthermore, the quality of evidence was downgraded because only half of the outcomes met the optimum information size, which is the number of participants needed for analysis to show a difference at a certain power [ 30 ] which means that for the other half of the outcomes, too few patients had been included collectively by the studies analyzed to reach any certainty as to which intervention provided a better or worse outcome.…”

Section: Resultsmentioning

confidence: 99%

Comparative Efficacy of Phacotrabeculectomy versus Trabeculectomy with or without Later Phacoemulsification: A Systematic Review with Meta-Analyses

Ahmadzadeh

Kessel

Subhi

et al. 2021

Journal of Ophthalmology

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There is no consensus on the surgical management of coexisting cataract in patients who undergo glaucoma surgery. In this study, we systematically reviewed the literature to compare the efficacy and safety of phacotrabeculectomy and trabeculectomy either alone or followed by later phacoemulsification. We systematically searched the literature databases PubMed/MEDLINE, EMBASE, and the Cochrane Central. Eligible studies were comparative trials of eyes with glaucoma that underwent either phacotrabeculectomy or trabeculectomy with or without later phacoemulsification. Our primary outcome measure was intraocular pressure (IOP) control closest to 12 months. Secondary outcome measures were efficacy closest to 12 months in terms of visual acuity, visual field, prevalence of complications, needling or revision, number of antiglaucomatous medications, and surgical success. We identified 25 studies with a total of 4,749 eyes. The IOP did not differ significantly between those who underwent phacotrabeculectomy versus trabeculectomy with (MD: 0.63, CI95%: −0.32, 1.59, p = 0.19 ) or without later phacoemulsification (MD: −0.52, CI95%: −1.45, 0.40, p = 0.27 ). However, phacotrabeculectomy was associated with lower risk of complications (RR: 0.80, CI95%: 0.67, 0.95, p = 0.01 ) and better visual acuity corresponding to a 1.4-line difference (MD: −0.14, CI95%: −0.27, −0.95, p = 0.03 ) compared to trabeculectomy. Other secondary outcome measures did not differ significantly (visual field, needling or revision, number of antiglaucomatous medications, and surgical success). In conclusion, postoperative IOP is comparable, and the number of complications is lower when phacotrabeculectomy is compared to trabeculectomy with or without later phacoemulsification in patients with coexisting glaucoma and cataract. However, our study also reveals that the level of evidence is low, and randomized clinical trials are warranted.

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Corneal Endothelial Cell Loss and Morphometric Changes 5 Years after Phacoemulsification with or without CyPass Micro-Stent

Lass

Benetz

et al. 2019

American Journal of Ophthalmology

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The effect of combined phacotrabeculectomy, trabeculectomy and phacoemulsification on the corneal endothelium in the early stage: a preliminary study

Cited by 11 publications

References 36 publications

Corneal endothelial cell loss after trabeculectomy and phacoemulsification in one or two steps: a prospective study

Corneal endothelial cell loss after trabeculectomy and phacoemulsification in one or two steps: a prospective study

Comparative Efficacy of Phacotrabeculectomy versus Trabeculectomy with or without Later Phacoemulsification: A Systematic Review with Meta-Analyses

Corneal Endothelial Cell Loss and Morphometric Changes 5 Years after Phacoemulsification with or without CyPass Micro-Stent

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