advertisement
Abstract #8055 Published in IGR 4-3
Phacoemulsification in eyes with functioning filtering blebs: a prospective study
Rebolleda G; Muñoz-Negrete FJOphthalmology 2002; 109: 2248-2255
OBJECTIVE: To evaluate the effect of phacoemulsification on intraocular pressure (IOP) control in eyes with a previous functioning filtering bleb and no glaucoma medication. DESIGN: Prospective, nonrandomized comparative (self-controlled) trial. PARTICIPANTS: Forty-seven patients (49 eyes) who underwent phacoemulsification after successful trabeculectomy, with at least 12 months of follow-up. INTERVENTION: Clear corneal phacoemulsification and implantation of a foldable intraocular lens in eyes that underwent a previous successful trabeculectomy. The time between both procedures was always greater than one year. MAIN OUTCOME MEASURES: Preoperative and postoperative IOP, the number of glaucoma medications, bleb appearance, and visual acuity were recorded at each follow-up examination. Success was defined as no need for glaucoma medications, bleb needling, or further glaucoma surgery for IOP control after phacoemulsification. Preoperative and intraoperative factors were evaluated for an association with postoperative failure using Kaplan-Meier survival analysis. RESULTS: The mean (± SD) IOP before phacoemulsification was 12.24 (± 4.68) mmHg, and it increased 3.94, 3.76, 1.39, 2.04, and 1.57 mmHg on the first postoperative day, after one, six, and 12 months, and at the last visit, respectively. At each interval, the mean IOP was significantly higher than the preoperative value (p = 0.000, 0.000, 0.049, 0.01, and 0.01, respectively). Nevertheless, the mean IOP after phacoemulsification was always lower than before trabeculectomy (p = 0.000). At the last visit, glaucoma medication was required in 17 eyes (34.7%). The success rates after phacoemulsification were 83.6%, 68.2%, and 55.7% at six months and one and two years, respectively (Kaplan-Meier survival analysis). The number of glaucoma medications used increased at all follow-up visits (p < 0.005). Bleb size decreased after phacoemulsification (p = 0.000). An IOP before phacoemulsification of greater than 10 mmHg was associated with postoperative failure (p = 0.002). Similarly, bleb failure and the need for glaucoma medication were associated with higher IOPs before phacoemulsification. CONCLUSIONS: Phacoemulsification significantly increased IOP and the number of glaucoma medications in eyes with preexisting functioning filtering blebs. Eyes with higher IOPs before phacoemulsification had worsened postoperative IOP control and bleb failure.
G. Rebolleda, MD, Hospital Ramón y Cajal, Ophthalmology Department, Glaucoma Unit, Carretera Colmenar Viejo km 9,1, E28034 Madrid, Spain
Classification:
12.8 Filtering surgery (Part of: 12 Surgical treatment)
12.12.3 Phacoemulsification (Part of: 12 Surgical treatment > 12.12 Cataract extraction)
