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Abstract #10219 Published in IGR 6-1
Surgical outcomes of combined phacoemulsification and glaucoma drainage implant surgery for Asian patients with refractory glaucoma with cataract
Chung AN; Aung T; Wang JC; Chew PTAmerican Journal of Ophthalmology 2004; 137: 294-300
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. DESIGN: Interventional case series. METHODS: A retrospective chart review was performed on all subjects who underwent combined phacoemulsification with intraocular lens implantation and glaucoma drainage implant surgery by a single surgeon at the National University Hospital, Singapore. The implants used were the 185 mm2 Ahmed glaucoma valve and the 350 mm2 Baerveldt glaucoma implant. In terms of IOP, complete success was defined as IOP of between 6 and 21 mmHg without medication, qualified success as IOP between 6 and 21 mmHg with one or more medication, and failure as a sustained IOP of > 21 or < 6 mmHg with or without one or more medication on two or more visits. RESULTS: A total of 32 combined phacoemulsification and glaucoma implant surgeries in 32 patients was performed. All patients were of Asian origin, and the mean age was 58 ± 16 years (range, 20-78 years). The Baerveldt glaucoma implant and Ahmed glaucoma valve implant were inserted in 16 eyes each. With a mean follow-up of 13 ± 5 months (range, 6-22 months), IOP was reduced from a mean of 28.0 ± 11.5 to 15.2 ± 6.0 mmHg postoperatively (p < 0.0001), whereas the number of antiglaucoma medications decreased from a mean of 2.4 ± 1.4 to.3 ± 0.7 (p < 0.0001) at last follow-up. Overall, there were 24 eyes (75%) that were classified as complete successes, four eyes (12.5%) that were qualified successes, and four eyes that failed (12.5%). Twenty-three eyes (72%) had improvement of visual acuity, while only one eye had a loss of more than one line of Snellen acuity. There was no case that encountered an intraoperative complication, and postoperative complications occurred in 12 eyes (38%), the most common of which was hypotony (in six eyes, 19%). CONCLUSIONS: For subjects with refractory glaucoma and cataract, combined phacoemulsification and glaucoma drainage implant surgery provide good visual rehabilitation and control of IOP, with low incidence of complications.
Dr. A.N. Chung, Department of Ophthalmology, National University Hospital, Singapore
Classification:
12.8.2 With tube implant or other drainage devices (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
12.14.3 Phacoemulsification (Part of: 12 Surgical treatment > 12.14 Combined cataract extraction and glaucoma surgery)