advertisement
Abstract #14235 Published in IGR 8-3
Comparison of two methods for glaucoma combined with a cataract
Sheng X-L; Xia M-H; Wang J; Zhang LInternational Journal of Ophthalmology 2006; 6: 373-376
AIM: To compare the effect of staged procedure versus combined procedure for primary angle-closer glaucomatous patients with coexisting cataract and better visual acuity. METHODS: We retrospectively evaluated the clinical course of 74 eyes from 68 patients with uncontrolled glaucoma and coexisting cataracts. The eyes were categorized into two groups according to whether staged-procedure or combined procedure. Group A: 36 eyes with triple procedure, cataract phacoemulsification and intraocular lens implantation combined with trabeculectomy with peripheral iridectomy. Preoperative visual acuity is 0.4-0.6. Mean follow-up was 12.2mo (range, 6-22mo). Group B: 38 eyes with staged procedure, after successful trabeculectomy, underwent cataract surgery by phacoemulsification techniques and intraocular lens implantation. The visual acuity before trabeculectomy was 0.4-0.8, before cataract phacoemulsification, 0.01 to 0.2. The average time from initial trabeculectomy to cataract phacoemulsification was 22.8mo (range, 8-52mo). We analyzed and compared the postoperative visual acuity (VA), intraocular pressure (IOP) and central anterior chamber depth between the two groups. RESULTS: In Group A, the postoperative VA of all patients improved in different degrees, with > 0.5 in 36 eyes (100%) and 31.0 in 20 eyes (56%). In Group B, the VA following cataract extraction was better than 0.5 in 28 eyes (74%) and 1.0 or better in 7 eyes (18%). There was statistically significant difference between the two groups (Χ2 = 8.40, P < 0.01,Χ2 = 11.00, P < 0.001). Mean intraocular pressure was lowered significantly from 27.15 ± 8.44 mmHg to 12.52 ± 3.25 mmHg in Group A (P < 0.001), from 26.56 ± 6.23 mmHg to 13.9 ± 4.25 mmHg in Group B after trabeculectomy (P < 0.001). In Group A, the IOP of 34 eyes (94%) wear controlled with trabeculectomy alone and 2 eyes (6%) were controlled with trabeculectomy and additional medical treatment. In Group B, the IOP of 29 eyes (76%) wear controlled with trabeculectomy alone, 5 eyes (13%) were controlled with trabeculectomy and additional medical treatment and in 4 eyes (10%), trabeculectomy with medical treatment failed to control the intraocular pressure. Following cataract extraction, the mean IOP increased insignificantly (P > 0.05) by 1.92 mmHg. The functional filtering bleb was not apparently cicatrized. The IOP wear controlled under 21 mmHg in 37 eyes (97%), 30 eyes (79%) without additional medical treatment and 7 eyes (18%) with additional medical treatment. The rate of IOP control without additional glaucoma medication was 94% in Group A, 71% in Group B at the time of the late investigation. There was statistically significant difference between the two groups (Χ2 = 6.98, P < 0.01). The central anterior chamber depth increased in all eyes in group A. The mean central anterior chamber depth deepened significantly (P < 0.05) from preoperative 1.62 ± 0.44 mm to postoperative 2.56 ± 0.38 mm. After trabeculectomy in Group B, the mean central anterior chamber depth decreased significantly (P < 0.05) from preoperative 1.68 ± 0.32mm to postoperative 1.06 ± 0.38 mm. Shallow anterior chamber occurred in 14 eyes (37%), with grade I in 10 eyes (26%), grade II in 3 eyes (8%) and grade III in 1 eye (3%). For the cataract extraction of Group B, narrow pupil, caused by the miotic therapy, posterior synechias or changes after glaucoma surgery, made the cataract phacoemulsification difficult in most of the cases. Due to intrasurgical difficulties, application of below additional surgical procedures was necessary: loosening of adhesions, mechanical pupillary dilation, tearing off fibrous or stained membrane, iridorrhaphy and pupil reconstruction. CONCLUSION: The triple procedure, combined ph acoemulsification, intraocular lens implantation and trabeculectomy is associated with better intraocular pressure control, better visual outcome and less intrasurgical difficulties than staged-procedure for angle-closer glaucomatous patients with coexisting cataract and better visual acuity. LA: Chinese
Dr. X.-L. Sheng, Department of Ophthalmology, The First People's Hospital of Economic and Technical Development Zone, Qingdao 266555 Shandong Province, China
Classification:
12.14.3 Phacoemulsification (Part of: 12 Surgical treatment > 12.14 Combined cataract extraction and glaucoma surgery)
