Trabeculectomy function after cataract extraction11None of the authors have any proprietary interest in any of the products mentioned in this article (original) (raw)
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Trabeculectomy function after cataract extraction
Ophthalmology, 1998
To examine the effect of cataract extraction (CE) after trabeculectomy on intraocular pressure (IOP) control. Design: Retrospective noncomparative case series. Participants: A total of 115 consecutive patients who underwent extracapsular CE (N 5 58) or phacoemulsification (N 5 57) with intraocular lens (IOL) placement after trabeculectomy were studied. Intervention: Cataract extraction with IOL after trabeculectomy was performed. Main Outcome Measures: Preoperative, intraoperative, and postoperative factors were evaluated for association with loss of IOP control requiring additional medications, bleb needling, or further glaucoma surgery, using Kaplan-Meier survival analysis and Cox multivariate proportional hazards survival regression. Results: After mean postoperative follow-up of 21.1 6 14.3 months, additional glaucoma medication or needling of the filtering bleb to maintain IOP control was required in 35 eyes (30.4%) and was significantly associated with intraoperative iris manipulation and early postoperative peak IOP greater than 25 mmHg. Additional glaucoma surgery was eventually required in 11 eyes (9.6%) and was significantly associated with age of 50 years or younger, preoperative IOP greater than 10 mmHg, and early postoperative peak IOP greater than 25 mmHg. The cumulative proportion of patients who did not require reoperation for glaucoma was 93% and 90% at 1 and 2 years, respectively. The mean IOP at last visit had increased 1.6 mmHg above the pre-CE level and did not vary significantly after the first postoperative month. The median interval from CE to the addition of glaucoma medication or bleb needling was 1.6 months (within 3 months in 20 of 33 eyes) and that from nonsurgical intervention to further glaucoma surgery was 3.6 months (before the 7th postoperative month in 6 of 11 eyes). Of 19 eyes with hypotony (IOP ∂ 6 mmHg) before CE, 11 eyes remained hypotonous after CE despite an increase in the mean IOP from 4.6 to 7.5 mmHg. Conclusions: When CE is performed after trabeculectomy, age of 50 years or younger, preoperative IOP greater than 10 mmHg, intraoperative iris manipulation, and early postoperative IOP greater than 25 mmHg are associated with worsened postoperative IOP control. Most bleb failures occur soon after CE. Resolution of pre-existing hypotony after CE is unpredictable.
Long-term post trabeculectomy intraocular pressures
Acta Ophthalmologica, 2009
Eighty-one eyes which had had trabeculectomy with a mean follow-up period of 9.2 years (range 7 to 10 years) were studied retrospectively for their subsequent pattern of intraocular pressure. Of 43 chronic open-angle glaucoma eyes, 29 (67%) had their pressures maintained below 21 mmHg by trabeculectomy alone over a 7-10-year period. On the other hand, 25 of 38 (65%) eyes with other types of glaucoma required an average of 1.5 different antiglaucoma medications post-op for the control of their intraocular pressures. Fifteen of 69 (22%) phakic eyes required cataract extraction at a mean of 5.1 years post-op. Two of 43 (5%) chronic open-angle glaucoma eyes suffered blinding complications attributable to the procedure. Seventeen percent: of eyes gained visual field at a mean of 7% of the pre-op field per year following trabeculectomy. Fifty percent lost field at a mean rate of 2.3% per year. Key words: open-angle glaucomatrabeculectomyintraocular pressurefollow-up studyvisual fields.
Long-term effect of cataract surgery on intraocular pressure after trabeculectomy
Journal of Cataract and Refractive Surgery, 2002
To compare the effect of phacoemulsification with intraocular lens (IOL) implantation on long-term intraocular pressure (IOP) control in glaucoma patients who had previous trabeculectomy with the effect on IOP control in similar patients after extracapsular cataract extraction (ECCE) with IOL implantation
Vojnosanitetski pregled
Background/Aim. Trabeculectomy is a safe procedure which effectively reduces the intraocular pressure (IOP). IOP is the most frequent indicator of success after glaucoma surgery. The aim of this work was to evaluate the long-term pressure control in primary open-angle glaucoma (POAG) and in pseudoexfoliative glaucoma (XFG) after primary trabeculectomy without the use of mitomycin-C (MMC), 3 to 5 years after trabeculectomy. Methods. This study involved a retrospective evaluation of 332 consecutive patients (352 eyes), 174 patients (188 eyes) with POAG (mean age of 64.0 ? 8.6 years) and 158 patients (164 eyes) with XFG (mean age of 70.7 ? 8.9 years) who underwent primary trabeculectomy between January 2007 and December 2009 at the Clinic for Eye Diseases, Clinical Center of Serbia in Belgrade. A successful control of IOP was defined as achieving IOP ? 21 mmHg without medication (complete success), or with a single topical medication (qualified success). Results. According to the type ...
Cataract Surgery After Trabeculectomy
Archives of Ophthalmology, 2012
Objective: To determine whether the timing of cataract surgery after trabeculectomy has an effect on trabeculectomy function in terms of intraocular pressure control.
‘Wipe-out’ after subscleral trabeculectomy in advanced glaucoma patients
Delta Journal of Ophthalmology, 2017
The aim of this study was to evaluate the safety of trabeculectomy in advanced glaucoma patients in the Egyptian population, and to detect postoperative wipe-out syndrome in high-risk patients. Patients and methods Thirty-six eyes of 33 patients with advanced glaucoma were included in the study. All patients underwent subscleral trabeculectomy. The patients were followed up for 3 months during which intraocular pressure (IOP), best-corrected visual acuity (BCVA), slit lamp biomicroscopy, fundus examination, and perimetry were done. Results The mean age of the study group was 51.17±2.64 years. The study included 24 males and nine females. The mean preoperative BCVA was 0.36±0.33. the mean IOP was 31±8.75 mmHg and the mean number of medications was 3.08±0.1. In all cases, complete success was achieved except for two cases with qualified success. The BCVA at day 90 showed no change in 21 eyes, visual decline in three eyes and visual gain in 12 eyes. A negative linear correlation was noticed between the percent reduction in IOP and the reduction in BCVA in the first postoperative day (r=−0.239) which was not statistically significant (P=0.162). The color of the neuroretinal rim was not a significant determinant for the final BCVA (P=0.48). Visual field changes showed no statistically significant differences. Conclusion Wipe-out phenomenon is not an ultimate postoperative outcome for filtering surgery in patients with advanced glaucoma. Pale neuroretinal rim and postoperative hypotony are risk factors for postoperative visual deterioration.
Acta Ophthalmologica Scandinavica, 2009
We studied 36 consecutive patients who underwent combined phacoemulsification and trabeculectomy to determine prognostic factors associated with intraocular pressure control one year postoperatively. In patients who were either easier (intraocular pressure < 16 mmHg, n = 19) or more difficult (2 16 mmHg, n = 17) to control, the mean intraocular pressure increased up to the fourth week postoperatively. In the more difficult to control group, however, the intraocular pressure continued to increase and a statistical difference between groups was noted by the second month postoperatively (P < 0.05). The peak intraocular pressure within the first month postoperatively was lower in patients easier to control long-term (P < 0.005). No statistical difference between groups in the filtering bleb or anterior chamber appearance, or postoperative complications, was noted (P > 0.05). This study suggests combined trabeculectomy and phacoemulsification is safe and effective in controlling intraocular pressure postoperatively. Determining from the early postoperative examination the long-term pressure control, however, is difficult. Key words: chronic open-angle glaucomatrabeculectomyphacoemulsification-glaucomaintraocular pressureprognosis.
Purpose: To compare intraocular pressure (IOP) reduction and to develop a predictive surgery calculator based on the results between trabectome-mediated ab interno trabeculectomy in pseudophakic patients versus phacoemulsification combined with trabectome-mediated ab interno trabeculectomy in phakic patients. Methods: This observational surgical cohort study analyzed pseudophakic patients who received trabectome-mediated ab interno trabeculectomy (AIT) or phacoemulsification combined with AIT (phaco-AIT). Follow up for less than 12 months or neovascular glaucoma led to exclusion. Missing data was imputed by generating 5 similar but non-identical datasets. Groups were matched using Coarsened Exact Matching based on age, gender, type of glaucoma, race, preoperative number of glaucoma medications and baseline intraocular pressure (IOP). Linear regression was used to examine the outcome measures consisting of IOP and medications. Results: Of 949 cases, 587 were included consisting of 235 AIT and 352 phaco-AIT. Baseline IOP between groups was statistically significant (p≤0.01) in linear regression models and was minimized after Coarsened Exact Matching. An increment of 1 mmHg in baseline IOP was associated with a 0.73±0.03 mmHg IOP reduction. Phaco-AIT had an IOP reduction that was only 0.73±0.32 mmHg greater than that of AIT. The resulting calculator to determine IOP reduction consisted of the formula -13.54+0.73 × (phacoemulsification yes:1, no:0) + 0.73 × (baseline IOP) + 0.59 × (secondary open angle glaucoma yes:1, no:0) + 0.03 × (age) + 0.09 × (medications). Conclusions: This predictive calculator for minimally invasive glaucoma surgery can assist clinical decision making. Only a small additional IOP reduction was observed when phacoemulsification was added to AIT. Patients with a higher baseline IOP had a greater IOP reduction.
Journal of Cataract & Refractive Surgery, 2008
A randomized, prospective, double-masked study was undertaken to determine the risk of postcycloplegic intraocular pressure spikes in patients with open-angle glaucoma and to evaluate apraclonidine prophylaxis in minimizing these spikes. Patients were stratified as miotic treated or untreated and each group was randomized to receive either placebo (artificial tears) or apraclonidine in both eyes before instillation of tropicamide. In both the miotic treated and untreated groups that received placebo, there was a high incidence, (37% and 38%, respectively) of clinically significant (~ 6 mmHg) intraocular pressure spikes after instillation of tropicamide. In both the miotic treated and untreated groups, there was a statistically significant difference in postcycloplegic intraocular pressure between the subgroup that received placebo and the group that received apraclonidine prophylaxis (P = 0.003 and P = 0.006, respectively).
PURPOSE: To stratify outcomes of trabectome-mediated ab interno trabeculectomy (AIT) by glaucoma severity using a simple and clinically useful glaucoma index. Based on prior data of trabectome after failed trabeculectomy, we hypothesized that more severe glaucoma might have a relatively more reduced facility compared to mild glaucoma and respond with a larger IOP reduction to trabecular meshwork ablation. METHODS: Patients with primary open angle glaucoma who had undergone AIT without any other same session surgery and without any second eye surgery during the following 12 months were analyzed. Eyes of patients that had less than 12 months follow up or were diagnosed with neovascular glaucoma were excluded. A glaucoma index (GI) was created to capture glaucoma severity based on visual field, number of preoperative medications, and preoperative IOP. Visual field (VF) was separated into 3 categories: mild, moderate, and advanced (assigned 1, 2, and 3 points, respectively). Preoperative number of medications (meds) was divided into 4 categories: ≤1, 2, 3 or ≥4, and assigned with a value of 1 to 4. Baseline IOP (IOP) was divided into 3 categories: 12-18 (Group 3) and >18 (Group 4). Linear regression was used to determine if there was an association between GI group and IOP reduction after one year or age, gender, race, diagnosis, cup to disc (C/D) ratio, and Shaffer grade. RESULTS: Out of 1340 patients, 843 were included in the analysis. The GI group distribution was GI1 = 164, GI2 = 202, GI3 = 260, and GI4 = 216. Mean IOP reduction after one year was 4.0±5.4, 6.4±5.8, 9.0±7.6, 12.0±8.0 mmHg for GI groups 1 to 4, respectively. Linear regression showed that IOP reduction was associated with GI group after adjusting for age, gender, race, diagnosis, cup to disc ratio, and Shaffer grade. Each GI group increase of 1 was associated with incremental IOP reductions of 2.95±0.29 mmHg. Success rate at 12 months was 90%, 77%, 77%, and 71% for GI groups 1 to 4. The log-rank test suggested significant differences between GI groups. CONCLUSION: A simple glaucoma index, GI, was created to capture glaucoma severity and a relative resistance to treatment. A higher GI was associated with a larger IOP reduction in trabectome surgery. This indicates that there is a role for AIT beyond mild glaucoma and ocular hypertension.