Surgical outcomes of combined phacoemulsification and glaucoma drainage implant surgery for Asian patients with refractory glaucoma with cataract (original) (raw)

Abstract

• PURPOSE: To examine the safety and efficacy of combined phacoemulsification and glaucoma drainage implant surgery in providing reduction of intraocular pressure (IOP) and visual rehabilitation in eyes with refractory glaucoma and cataract.

Figures (5)

FIGURE 1. Intraocular pressure distribution preoperatively and during follow-up at months 1, 3, 6, 9, 12 and last visit for subjects undergoing combined phacoemulsification and glaucoma drainage implant surgery. Open box = mean; horizontal lines = 95% confidence interval.

FIGURE 1. Intraocular pressure distribution preoperatively and during follow-up at months 1, 3, 6, 9, 12 and last visit for subjects undergoing combined phacoemulsification and glaucoma drainage implant surgery. Open box = mean; horizontal lines = 95% confidence interval.

TABLE 3. Intraocular Pressure, Overall Outcome, and Number of Medications Before and After Combined Phacoemulsification and Glaucoma Drainage Implant Surgery Cataract surgery by itself has been reported to cause a reduction in IOP.2°-23 Mechanisms that have been pro- posed to account for such a reduction in IOP after cataract surgery include reduction of ciliary body aqueous produc- tion by capsular bag contraction, deepening of the anterior chamber angle, and enhanced outflow by stretching of the trabecular meshwork.2°-*3 The effect of cataract surgery on the functioning of glaucoma drainage implant blebs is not known. Inflammatory mediators and cells released during cataract extraction could flow through the tube and stimulate further scarring around the plate reservoir. Sub- sequent increased thickening of the fibrous capsule around the plate could lead to a hypertensive phase. However, outflow of these inflammatory cells and angiogenic factors may also help in preventing the progression of the primary disease process, especially in the case of uveitic and neovascular glaucoma.

TABLE 3. Intraocular Pressure, Overall Outcome, and Number of Medications Before and After Combined Phacoemulsification and Glaucoma Drainage Implant Surgery Cataract surgery by itself has been reported to cause a reduction in IOP.2°-23 Mechanisms that have been pro- posed to account for such a reduction in IOP after cataract surgery include reduction of ciliary body aqueous produc- tion by capsular bag contraction, deepening of the anterior chamber angle, and enhanced outflow by stretching of the trabecular meshwork.2°-*3 The effect of cataract surgery on the functioning of glaucoma drainage implant blebs is not known. Inflammatory mediators and cells released during cataract extraction could flow through the tube and stimulate further scarring around the plate reservoir. Sub- sequent increased thickening of the fibrous capsule around the plate could lead to a hypertensive phase. However, outflow of these inflammatory cells and angiogenic factors may also help in preventing the progression of the primary disease process, especially in the case of uveitic and neovascular glaucoma.

FIGURE 2. Kaplan-Meier survival curve for patients undergoing combined phacoemulsification and glaucoma drainage implan surgery (both types of implants).

FIGURE 2. Kaplan-Meier survival curve for patients undergoing combined phacoemulsification and glaucoma drainage implan surgery (both types of implants).

TABLE 4. Visual Outcomes of Combined -hacoemulsification and Glaucoma Drainage Implant Surgery (Pre-op to Last Follow-up) time of glaucoma implant led to an increased rate of this hypertensive phase. We speculate that racial differences in the scarring response!! may also affect the pathogenesis of this phenomenon.

TABLE 4. Visual Outcomes of Combined -hacoemulsification and Glaucoma Drainage Implant Surgery (Pre-op to Last Follow-up) time of glaucoma implant led to an increased rate of this hypertensive phase. We speculate that racial differences in the scarring response!! may also affect the pathogenesis of this phenomenon.

TABLE 5. Early and Late Postoperative Complications Encountered the follow-up period only about a year. In common with many other studies of glaucoma implants, data on optic nerve and visual field progression was difficult to obtain. Nevertheless, the results of this study provide valuable information on Asian eyes that, by virtue of their under-

TABLE 5. Early and Late Postoperative Complications Encountered the follow-up period only about a year. In common with many other studies of glaucoma implants, data on optic nerve and visual field progression was difficult to obtain. Nevertheless, the results of this study provide valuable information on Asian eyes that, by virtue of their under-

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