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Phaco-trabeculectomy equals trabeculectomy in lowering IOP-A 4 years follow-up study


Wachtl, J; Töteberg-Harms, M; Frimmel, S; Kniestedt, C (2016). Phaco-trabeculectomy equals trabeculectomy in lowering IOP-A 4 years follow-up study. Journal of Clinical & Experimental Ophthalmology, 7(6):1000622.

Abstract

Objective: The aim of this study was to compare the long-term efficacy and safety of combined phacotrabeculectomy (phaco-trab) and trabeculectomy (trab) alone.
Methods: Retrospective, non-randomized, interventional case series of phaco-trab and trab. Inclusion criteria were diagnosis of glaucoma for both plus vision impairing coexisting cataracts for phaco-trab. Primary outcome measures were change in intraocular pressure (IOP) and number of anti-glaucoma drugs (AGD) at 1 y and 4 ys after surgery, and postoperative interventions (i.e. laser suture lysis, 5-Fluorouracil injection, needling). Secondary outcome measures were visual acuity and complications. Success was defined based on the criteria from the tubeversus- trabeculectomy study.
Results: Mean age was 73.6 ± 8.7 years (28% males; 51% right eyes). Median preoperative IOP was reduced from 22.8 mmHg to postoperative 13.0 mmHg at 1 y and to 14.0 mmHg at 4 ys after phaco-trab (n=62), or in trab alone (n=72) from 21.8 mmHg to 12.0 mmHg at 1 y and 4 ys. AGD were reduced from 2.5 ± 0.8 to 0.1 ± 0.3 1 y and 0.2 ± 0.6 4 ys after phaco-trab, and from 2.6 ± 1.0 to 0.2 ± 0.5 AGD 1 y and 4 ys after trab alone. Both IOP and AGD reduction were statistically indifferent between the groups at all-time points. Mean number of postoperative interventions was 2.1 for phaco-trab and 1.8 for trab (p=0.64). 75% of phaco-trab and 74% of trab eyes fulfilled the criteria for complete success after 4 ys (p=0.844).
Conclusion: Both procedures resulted in an equally successful and stable long-term reduction of IOP to the lower teens and AGD requirement, together with a good safety profile. The high number of postoperative interventions in both groups emphasizes the importance of a close follow-up. We therefore conclude that if a close and careful postoperative follow-up can be guaranteed, phaco-trabeculectomy should be the treatment of choice for patients with coexisting cataract and otherwise uncontrolled IOP.

Abstract

Objective: The aim of this study was to compare the long-term efficacy and safety of combined phacotrabeculectomy (phaco-trab) and trabeculectomy (trab) alone.
Methods: Retrospective, non-randomized, interventional case series of phaco-trab and trab. Inclusion criteria were diagnosis of glaucoma for both plus vision impairing coexisting cataracts for phaco-trab. Primary outcome measures were change in intraocular pressure (IOP) and number of anti-glaucoma drugs (AGD) at 1 y and 4 ys after surgery, and postoperative interventions (i.e. laser suture lysis, 5-Fluorouracil injection, needling). Secondary outcome measures were visual acuity and complications. Success was defined based on the criteria from the tubeversus- trabeculectomy study.
Results: Mean age was 73.6 ± 8.7 years (28% males; 51% right eyes). Median preoperative IOP was reduced from 22.8 mmHg to postoperative 13.0 mmHg at 1 y and to 14.0 mmHg at 4 ys after phaco-trab (n=62), or in trab alone (n=72) from 21.8 mmHg to 12.0 mmHg at 1 y and 4 ys. AGD were reduced from 2.5 ± 0.8 to 0.1 ± 0.3 1 y and 0.2 ± 0.6 4 ys after phaco-trab, and from 2.6 ± 1.0 to 0.2 ± 0.5 AGD 1 y and 4 ys after trab alone. Both IOP and AGD reduction were statistically indifferent between the groups at all-time points. Mean number of postoperative interventions was 2.1 for phaco-trab and 1.8 for trab (p=0.64). 75% of phaco-trab and 74% of trab eyes fulfilled the criteria for complete success after 4 ys (p=0.844).
Conclusion: Both procedures resulted in an equally successful and stable long-term reduction of IOP to the lower teens and AGD requirement, together with a good safety profile. The high number of postoperative interventions in both groups emphasizes the importance of a close follow-up. We therefore conclude that if a close and careful postoperative follow-up can be guaranteed, phaco-trabeculectomy should be the treatment of choice for patients with coexisting cataract and otherwise uncontrolled IOP.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Ophthalmology Clinic
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2016
Deposited On:12 Jan 2017 15:41
Last Modified:08 Dec 2017 22:07
Publisher:OMICS Publishing Group
ISSN:2155-9570
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.4172/2155-9570.1000622

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