Marginally controlled open angle glaucoma and cataract: sequential (1st phacoemulsification,2nd trabeculectomy) versus combined (phacotrabeculectomy) surgery
Purpose glaucoma patients with borderline controlled intraocular pressure (IOP) may benefit from cataract surgery alone. However it is possible that these patients may need glaucoma surgery at some point in the future. Furthermore the risk of postoperative IOP spikes and the inconvenience of two ope...
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| Published in: | Acta ophthalmologica (Oxford, England) Vol. 90; no. s249 |
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| Main Authors: | , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Oxford, UK
Blackwell Publishing Ltd
01-09-2012
Wiley Subscription Services, Inc |
| Subjects: | |
| Online Access: | Get full text |
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| Summary: | Purpose glaucoma patients with borderline controlled intraocular pressure (IOP) may benefit from cataract surgery alone. However it is possible that these patients may need glaucoma surgery at some point in the future. Furthermore the risk of postoperative IOP spikes and the inconvenience of two operations (sequential) should be weighed against the complexity of the combined operation. The purpose of the study is to compare the results of phacotrabeculectomy with trabeculectomy in clear corneal incision pseudophacic eyes.
Methods retrospective study of 31 patients with visually significant cataract and open angle glaucoma with IOP 22‐25 mmHg on topical medications. The patients were assigned to either surgical treatment according to their glaucoma severity. 20 patients underwent combined phacotrabeculectomy (two‐sites) and 11 patients underwent sequential (1st phacoemulsification(temporal clear corneal incision with intraocular lens implantation), 2nd trabeculectomy). Antimetabolites and adjustable sutures were used in all glaucoma operations. IOP measurements were recorded. Follow up time was 6‐18 months (median 12 months).
Results the effect of type of surgical treatment on postoperative IOPs was not statistically significant. Combined phacotrabeculectomy resulted in higher IOPs by 0.97(95% Confidence Interval [‐1.6 3.59]) mmHg (p=0.47) versus sequential surgery.
Conclusion in patients with clinically significant cataract and glaucoma with borderline control of IOP the choice of combined (phacotrabeculectomy) versus sequential (1st phaco, 2nd trabeculectomy) surgery can be done according to the severity of glaucoma and based on surgeon’s preference and experience. |
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| ISSN: | 1755-375X 1755-3768 |
| DOI: | 10.1111/j.1755-3768.2012.4457.x |