The long-term outcome of trabeculectomy in advanced glaucoma

PURPOSE: We evaluated retrospectively the surgical outcome of trabeculectomy in patients with advanced glaucoma. METHODS: We studied 18 eyes of 18 patients with advanced glaucoma (mean age: 71.2 years, mean follow-up period: 41.1 months). In each eye, the visual field was at stage 5 of Aulhorn-Greve's classification before surgery. RESULTS: Two eyes showed extreme hypotony (< 2 mmHg) 3 days after surgery and lost the central visual field permanently. Another 2 of 4 eyes which could not be maintained below 15 mmHg showed a worsening of visual field disturbance within stage 5 of Aulhorn-Greve's classification. The final visual acuity was 0.7 or better in 9 eyes (50.0%), 0.1 or worse in 2 eyes (11.1%). The final intraocular pressure (IOP) was below 10 mmHg without and with medication in 8 eyes (44.4%) and 2 eyes (11.1%) respectively. The final IOP was below 15 mmHg without and with medication in 11 eyes (61.1%) and 3 eyes (16.7%) respectively. Postoperative complications were observed in 4 eyes (22.2%). CONCLUSIONS: The cause of postoperative central visual field worsening was associated with extreme intraocular hypotony (2 mmHg) rather than IOP elevation due to bleb dysfunction. This surgery may be effective as 14 eyes (78%) were able to maintain visual acuity and the central visual field.     

丝裂霉素C联合粘小管成形术治疗开角型青光眼的疗效

目的:评估丝裂霉素C(MMC)联合粘小管成形术治疗开角型青光眼的效果.方法:回顾性研究.收集2007-12/2014-03接受粘小管成形术患者104例122眼.记录术前术后眼内压(IOP),青光眼用药数量,视力,并发症,辅助治疗(激光前房角穿刺或青光眼用药)和成功率.IOP≤21 mmHg无额外用药为完全成功,IOP≤21 mmHg有或无青光眼用药为部分成功.结果:术前平均IOP为27.5±9.2 mmHg,术后平均IOP为14.5±6.6 mmHg(P<0.001).术前平均视力为0.42±0.4,术后为0.32±0.4 (P=0.726).部分成功106眼(86.9%),完全成功62眼(50.8%).激光前房角穿刺术43眼(35.2%),青光眼药物使用率为49.1%.术后平均随访27.29±16.78 (1~79)mo.结论:粘小管成形术并发症发生率低且术后视力稳定,是一种安全的选择,术后补充进行激光前房角穿刺术可以提高手术成功率.丝裂霉素C对于粘小管成形术的作用还需进行深入的比较研究.     

Intraocular pressure the day of argon laser trabeculoplasty in primary open-angle glaucoma

Argon laser trabeculoplasty was performed in one eye of 57 phakic patients with primary open-angle glaucoma. The eyes received a mean of 78 +/- 7 treatments over 360 degrees to the anterior trabecular meshwork. The power was titrated to produce blanching without bubble formation. Increased intraocular pressure (range +1 to +22 mmHg) occurred in 30 of the 57 (53%) eyes 1 hour after treatment. Eight (14%) of these eyes had a clinically significant elevation defined by all of three criteria: (1) an intraocular pressure greater than 30 mmHg, (2) greater than a 30% increase over the mean prelaser intraocular pressure, and (3) greater than a 10 mmHg increase over the peak prelaser diurnal intraocular pressure curve. These eight patients received either oral glycerine or acetazolamide. A rebound increase in intraocular pressure requiring repeat medical treatment occurred in four of the eight eyes. Two additional eyes without a pressure elevation 1 hour after treatment showed a later elevation. This was first detected 4 hours postoperatively in one eye and 7 hours after treatment in another eye. The 1-hour postoperative measurement detected most patients with clinically significant increased intraocular pressure (8 of 10 eyes) but these required continued observation for rebound increases. Patients with advanced glaucomatous visual field loss should also be followed closely to detect late increases in intraocular pressure (2 of 10 eyes).     

Management and prognosis of end-stage glaucoma

Purpose : We followed, for a long term, end‐stage glaucoma patients as defined by the level of legal blindness. Methods : Follow up was for 7.7 ± 1.8 years (range 2–9) for 22 patients (13 men and nine women) having 32 eyes with functional vision. Age at exit was 74.6 ± 15.5 years (range 33–89). Humphrey computerized perimetry and applanation tonometry were used throughout. We attempted to hold intraocular pressure below 15 mmHg using as much medical therapy as required. Results : All visual fields were less than 10° diameter at exit, but at entry seven eyes of six patients still had a field between 10º and 20°, the rest were all less than 10°. Corrected visual acuity at entry was 6/9 to 6/6 in 21 eyes of 16 patients and none had less than 6/60. At exit 16 eyes had 6/9 to 6/6 and five eyes had less than 6/60, but no patient had complete loss of vision. Mean intraocular pressure (IOP) throughout was below 15 mmHg in all but four patients, whose (IOP) were less than 20 mmHg, using multiple medications if necessary. All patients had undergone prior surgery and/or laser trabeculoplasty. Conclusions : Even though visual loss slowly progressed, most patients with end‐stage glaucoma retained functional vision for a long period when intraocular pressure was held below 15 mmHg. More stringent early control of intraocular pressure may avoid the development of end‐stage glaucoma.     

Cataract surgery in patients with acute primary angle-closure glaucoma

We investigated the results of cataract surgery in acute angle-closure glaucoma patients whose intraocular pressure (IOP) was not controlled with conventional treatment. We compared postoperative IOP and best corrected visual acuity (BCVA) with preoperative data in 10 eyes of 10 patients who had undergone cataract surgery for acute angle-closure glaucoma. Initial and preoperative mean IOP were 50.0 +/- 6.4 mmHg and 34.9 +/- 9.3 mmHg, respectively. Mean follow-up was 6.3 +/- 5.9 months. Postoperative mean IOP was 12.0 +/- 4.2 mmHg. All eyes were controlled at less than 21 mmHg and seven of them (70%) were controlled at less than 21 mmHg without medication. Postoperative BCVA was improved in 9 eyes. The complications were transient IOP elevation in 2 eyes and exudative membrane in 4. Cataract surgery may be effective to control IOP and improve visual acuity in patients with acute angle-closure glaucoma. However, follow up is necessary because of a high incidence of postoperative complications.     

Trabeculotomy combined with phacoemulsification and implantation of intraocular lens for primary open-angle glaucoma

Retrospective study examined the surgical effects of lowering intraocular pressure of trabeculotomy combined with phacoemulsification and implantation of an intraocular lens. Included in the retrospective study were 96 eyes of 64 patients with primary open-angle glaucoma. Preoperative mean IOP was 25.6 mmHg. At final examination, the IOP was well-controlled at 21 mmHg or lower without medications in 32 of 96 eyes. In another 62 eyes, the IOP was well-controlled with antiglaucoma medications. The postoperative IOPs were in the high teens after surgery. The life table analysis using Kaplan-Meier methods showed that the success probability after phacoemulsification and implantation of intraocular lens, combined with trabeculotomy (PIT)-I and PIT-II, were 93.9% and 82.6% at 4 years, respectively. Postoperative visual acuity improved by more than two lines in 79 of the 96 eyes. In no case was the visual acuity decreased by more than two lines. Deterioration of the visual field was found in 4 eyes. There were no complications such as shallow anterior chamber, choroidal detachment, malignant glaucoma, hypotonic maculopathy, and endophthalmitis. This triple procedure should be performed in the early stages of glaucoma.     

Long-term evaluation of trabeculectomy in primary open angle glaucoma and chronic primary angle closure glaucoma in an Asian population

Purpose: A retrospective cohort study was undertaken to evaluate and compare the long‐term results of trabeculectomy in primary open angle glaucoma (POAG) and chronic primary angle closure glaucoma (CPACG) in an Asian population. Methods: Yearly diurnal measurements of intraocular pressure (IOP), best‐corrected visual acuity, optic disc and visual field records of patients having primary adult glaucomas who had undergone trabeculectomy, without anti­mitotic agents, with a minimum of 5 years follow up were evaluated. Only one eye of each patient was studied. The success rates for IOP control in POAG and CPACG were statistically analysed. Results: Sixty‐four eyes of 64 patients were studied. The overall probability of success of trabeculectomy in controlling IOP to ≤21 mmHg with or without additional topical antiglaucoma medication was 0.94 and 0.88 at 5 and 10 years, respectively. There was no statistically significant difference in the qualified and absolute success rates for IOP control between POAG and CPACG eyes (log rank test P= 0.6, 0.88, respectively). Twelve of 38 CPACG eyes had a two‐line decrease in visual acuity as compared to four of 26 POAG eyes (P = 0.17). Progression or development of a cataract was the most common cause of visual decline. Conclusions: Trabeculectomy without antimetabolite use appears to be efficacious in lowering IOP and in visual field preservation over a period of 10 years in both POAG and CPACG. Development/progression of cataract especially in eyes with chronic angle closure glaucoma after trabeculectomy must be considered an important issue.     

Results of combined phacoemulsification and viscocanalostomy in patients with cataract and pseudoexfoliative glaucoma

PURPOSE: Coexisting pseudoexfoliation glaucoma (PEXG) and cataract represents a special challenge. Although phacotrabeculectomy is an effective procedure, it combines the risks of phacoemulsification and trabeculectomy. This study evaluates phacoviscocanalostomy to manage eyes with PEXG and cataract. METHODS: We conducted a prospective noncomparative study that included 30 consecutive eyes of 22 patients with uncontrolled PEXG and cataract. Phacoviscocanalostomy was performed in all. Success rate based on postoperative intraocular pressure (IOP) reduction and requirement for topical antiglaucoma medication was evaluated as the main outcome measure. Visual acuity and complication rates were secondary outcomes. RESULTS: The mean follow-up was 18.6 months +/-6.2 (SD) (range 12 to 36 months). There was statistically significant decrease in mean IOP from 25.3+/-5.2 mmHg preoperatively to 13.5+/-6.0 mmHg 1 day after surgery (p< .05), 12.3+/-3.1 mmHg at the final follow-up (p< .05), and at all evaluations to the last postoperative visit. Only three eyes (10%) required a single antiglaucoma medication to achieve the target IOP. A complete surgical success (IOP <21 mmHg without medication) was achieved in 90%, while a qualified success (IOP <21 mmHg with or without glaucoma medication) was achieved in 100% of cases. Complications included Descemet membrane microperforations (13.3%), macroperforation (3.3%), zonular dehiscence (6.6%), and transient postoperative IOP spike (3.3%). CONCLUSIONS: Phacoviscocanalostomy achieved excellent IOP control and visual acuity improvement in pseudoexfoliation patients with coexisting cataract and glaucoma. Complication rate was low and did not affect the surgical outcome.     

Intraocular lens implantation after glaucoma filtering surgery--time course of changes in intraocular pressure control and filtering blebs]

Cataract extraction and intraocular lens (IOL) implantation were carried out in 45 glaucomatous eyes that had undergone glaucoma filtering surgery. Of these, 37 eyes had primary glaucoma, 2 eyes capsular glaucoma, and 6 eyes secondary glaucoma. The visual acuity after IOL implantation was 0.5 or more in 29 eyes (64%) but in 10 eyes (22%) acuity was 0.1 or less because of advanced optic nerve head damage. To analyze affects of IOL implantation on intraocular pressure (IOP) control and functioning of the filtration bleb in 39 eyes of primary or capsular glaucoma, a life-table analysis with the Kaplan-Meier method was performed. The probability that IOP control does not worsen at 2 years was 43 +/- 7% (SE) in 21 eyes without pre-operative ocular hypotensive medication, 56 +/- 16% in 18 eyes with pre-operative ocular hypotensive medication, 47 +/- 12% in 26 eyes where functioning filtering bleb existed pre-operatively. The probability that the filtering bleb survives 2 years post-operatively was 44 +/- 11%. The present results imply that intensive management of post-operative inflammation and careful IOP follow up are imperative in eyes in which IOL implantation was indicated after undergoing filtration surgery.     

Surgical management of glaucoma in infants and children with Peters' anomaly: long-term structural and functional outcome

OBJECTIVE: To determine the long-term outcome of surgery for congenital glaucoma in infants and children with Peters' anomaly. DESIGN: Retrospective review of a consecutive interventional case series. SETTING: An urban academic tertiary referral institution. PARTICIPANTS: Thirty-four eyes of 19 children are subjects of this report. Included are all children 12 years of age or younger with Peters' anomaly who underwent surgery for primary congenital glaucoma between January 1971 and December 1992 and completed a minimum of 3 years of follow-up from the date of the first glaucoma surgery. INTERVENTION: The surgical procedures performed were trabeculectomy, trabeculotomy, goniotomy, Molteno shunt implantation, cyclodialysis, and cyclocryotherapy. MAIN OUTCOME MEASURES: Primary outcome measures were intraocular pressure (IOP) control and final postoperative visual acuity. Intraocular pressure control was defined as complete success (IOP21 mmHg with or without antiglaucoma medication, inoperable retinal detachment, phthisis, or chronic hypotony, defined as an IOP of 相似文献   

Combined phacoemulsification and Ahmed valve glaucoma drainage implant: a retrospective case series

PURPOSE: To report on the efficacy and safety of combined phacoemulsification and an Ahmed valve glaucoma drainage implant with respect to visual acuity improvement, intraocular pressure (IOP) control, and requirement for antiglaucoma medication. METHODS: A retrospective chart review was conducted of 41 eyes (31 patients) with coexisting visually significant cataracts and uncontrolled glaucoma who had combined phacoemulsification and Ahmed valve implantation. The outcome measures were: visual acuity, IOP, antiglaucoma medication requirements, and intra- and post-operative complications. Success was categorized as absolute (IOP<21 mmHg without the need for antiglaucoma medication) and relative (IOP<21 mmHg with one or more antiglaucoma medications). Failure was considered to be an IOP<6 mmHg or IOP>21 mmHg on maximally tolerated medications or any devastating complication. RESULTS: The mean patient age was 67.3+/-5.9 years old. The mean visual acuity improved from 0.73+/-0.5 to 0.16+/-0.16 (p=0.000). The mean IOP decreased from 28.2+/-3.1 to 16.8+/-2.1 (p=0.000, 40.4%), while the number of antiglaucoma medication decreased from 2.6+/-0.66 to 1.2+/-1.4 (p=0.000). The absolute and relative success rates were 56.1% and 31.7%, respectively; 5 eyes (12.2%) were considered failures. There were no intraoperative complications; postoperative complications occurred in 8 eyes (19.5%). A hypertensive phase was detected in 12 (29.3%) eyes. CONCLUSIONS: Combined phacoemulsification and Ahmed valve glaucoma drainage implantation is a safe and effective alternative to phacotrabeculectomy in patients with coexisting cataract and refractory glaucoma.     

A case of steroid-induced glaucoma after radial keratotomy

BACKGROUND: We report a patient who was diagnosed as having steroid-induced glaucoma after radial keratotomy(RK) and suffered from severe visual field defect. CASE: A 29-year-old man underwent RK for both eyes. After the operation, he was treated for six months with topical medication including 0.1% and 0.01% betamethasone without measuring intraocular pressure(IOP). When he consulted an ophthalmologist, his IOP was 43 mmHg in the right eye and 51 mmHg in the left eye. At our initial examination, his IOP was 8 mmHg in the right eye and 10 mmHg in the left eye with 750 mg acetazolamide peroral, 0.5% timolol maleate, and latanoprost eyedrops. There were RK 16 incisions on the cornea and we found severe glaucomatous visual field loss. Finally we performed trabeculotomy in both eyes for IOP control with conservative therapy. CONCLUSION: As the keratorefractive surgery becomes popular, we must be careful of problems, such as steroid-induced glaucoma, and the change of refraction following the change of IOP.     

The combination of guanethidine 3% and adrenaline 0.5% in 1 eyedrop (GA) in glaucoma treatment.

During a 7-month period 33 patients (20 with primary open-angle glaucoma and 13 with suspected glaucoma) were treated with guanethidine 3% and adrenaline 0.5% in 1 eyedrop twice daily. The previous therapy was discontinued and the aim of the trial was to treat the patients with GA alone. There was an average decrease in intraocular pressure of 10.8 mmHg or 37.5% for the whole group (including 5 patients with additional therapy). In eyes with an average IOP in a day-curve without medication equal to or higher than 28 mmHg we found a decrease of 44.6% or 14.4 mmHg, and in eyes with an average IOP without medication between 21 and 28 mmHg a decrease of 30.4% or 7.6 mmHg. With GA alone the IOP was 3.3 to 3.9 mmHg lower than on the previous therapy (P less than 0.05); 46% of the eyes without additional therapy had all IOPs lower than 22 mmHg and 74% of the eyes had IOPs lower than 22 mmHg except 1 with a peak lower or equal to 25 mmHg 3 hours after application. This peak 3 hours after application indicates that GA has a biphasic action and was significant at the 0.5% level. Red eyes and slight ptosis were no problem for most patients. Patients found it very convenient to administer GA only twice daily.     

Trabeculectomy: A Retrospective Follow-up of 700 Eyes

A major focus of our study was to determine the value of postoperative intraocular pressure (IOP) in predicting the outcome of trabeculectomy (TE). The medical charts of 547 patients undergoing glaucoma filtering surgery at the Department of Ophthalmology of the University of Cologne from 1987 to 1996 were reviewed. The status of the visual field, level of visual acuity, appearance of the bleb, cup/disc ratio and IOP were studied. Pre- and post-operative glaucoma medication was recorded. The eyes with congenital glaucoma and those treated with anti-metabolites were excluded. The results are presented with particular emphasis being placed not only on intraocular pressure (IOP) control but also on the progression of glaucomatous damage (deterioration of visual field or disc damage) and the decrease of visual acuity. The tonometric success rate of TE in controlling the IOP <21 mmHg was 61%. Defining the rigid criteria for success of trabeculectomy as an IOP <21 mmHg, no further visual field loss, no disc damage and no additionally required surgical intervention due to glaucoma, the success rate decreased to 44%. The results indicate that other factors than normalization of IOP determine the success rate of TE. Should trabeculectomy be the therapy of first choice in the early stage of glaucoma? Should trabeculectomy fail to control the IOP in the first eye, would this allow options, such as the use of antimetabolites in the second eye?     

The medium and long-term efficacy of primary argon laser trabeculoplasty in avoiding topical medication in open angle glaucoma.

PURPOSE: To study the medium and long-term efficacy of primary argon laser trabeculoplasty in open angle glaucoma with especial emphasis on avoidance of additional medical therapy. METHODS: Records of 168 patients with chronic open angle glaucoma or pseudoexfoliation glaucoma who underwent primary argon laser trabeculoplasty between 1987 and 1995 were studied retrospectively (duration of follow-up 1-8 years, mean 4.1 years). Mean baseline intraocular pressure was 28.7 mmHg (range 22-60 mmHg). Need of additional medical therapy was in each case evaluated at the surgeons' discretion, and the results were analysed by survival analysis. RESULTS: The probability of treatment success (no medication required) was for chronic open angle glaucoma 77% after 2 years, 67% after 5 years and 67% after 8 years Corresponding numbers for pseudoexfoliation glaucoma were 80%, 54% and 36%. Prelaser IOP higher than 31 mmHg, pretreatment visual field defect and sparse pigmentation of the trabecular meshwork were independent predictors of failure. CONCLUSION: Primary argon laser trabeculoplasty gives a long-lasting and favourable effect in chronic open angle glaucoma where 2/3 of the eyes still managed without additional medication for 8 years. The success in pseudoexfoliation glaucoma was even higher the first 3 years, and kept above 50% for 5 years. This makes laser a valuable option as first choice of therapy in glaucoma.     

Molteno implant surgery in uncontrolled glaucoma

Molteno implant surgery was performed on 33 eyes of 29 patients with complicated and uncontrolled glaucoma. Average preoperative IOP was 34.0 +/- 8.8 mmHg. After a mean postoperative follow-up period of 18.3 months the IOP was 15.8 +/- 8.3 mmHg. Three patients had an IOP over 22 mmHg. Overall, success rate was 73% with IOP and medication as criteria. In 75% of eyes visual acuity improved or remained within two lines of the preoperative value. The highest success rate was 83% (10 of 12 eyes) in congenital and uveitic glaucoma when both IOP, medication and visual acuity were taken into account. At the end of the study 52% of eyes were controlled without medication. Complications included transient hyphema (21%), flat anterior chamber with hypotony, with or without choroidal detachment (12%), tube touch to lens or cornea (9%), and tube block with vitreous (3%).     

白内障小切口囊外摘除联合小梁切除治疗PACG合并白内障

目的：观察白内障小切口囊外摘除联合小梁切除术治疗原发性急性、慢性闭角型青光眼的疗效。

方法：急性闭角型青光眼合并白内障23例24眼,慢性闭角型青光眼合并白内障11例12眼,进行白内障小切口囊外摘除联合小梁切除术,均一期植入人工晶状体。

结果：术后随访1mo,急性闭角型青光眼组术前平均眼压30.68±7.60mmHg,术后17.83±5.95mmHg,差异有统计学意义(P<0.05); 慢性闭角型青光眼组术前平均眼压29.27±5.55mmHg,术后18.12±1.88mmHg,差异有统计学意义(P<0.05)。术前、术后两组间平均眼压差异无统计学意义。术后眼压控制良好者(6～21mmHg)者26眼(72%),局部使用抗青光眼药物后眼压控制良好者8眼(22%),总体有效控制率94%,眼压不能控制者(22～30mmHg)2眼(6%); 术后视力提高者32眼(89%),没有发生严重并发症。

结论：白内障小切口囊外摘除联合小梁切除术对于原发性闭角型青光眼(PACG)合并白内障的治疗可以有效控制眼压、提高视力,并发症少; 其在控制眼压方面对于原发性急/慢性闭角型青光眼无差异。     

The evaluation of the efficacy of treatment in glaucoma associated with Sturge-Weber syndrome

PURPOSE: To estimate the efficiency of glaucoma treatment in Sturge-Weber syndrome. MATERIAL AND METHODS: 4 patients with Sturge-Weber syndrome and the consecutive glaucoma seen at the Department of Ophthalmology in Bialystok between the years 1999-20005, were reviewed. Glaucoma associated with Sturge-Weber syndrome was diagnosed at the age of 6 months in 1 patient, of 10-11 years in 2 patients and of 14 years in 1 patients. All patients underwent surgery. 2 eyes underwent trabeculectomy and 2 eyes had nonpenetrating deep sclerectomy with SKGel implant. RESULTS: Before the surgery the intraocular pressure was 35.2 mmHg (range from 25 to 48 mmHg). All patients required anti-glaucoma medications after surgery to keep intraocular pressure less than 22 mmHg. After surgery the mean intraocular pressure was 26.25 mmHg (range from 22 to 32 mmHg). 2 patients required 2 medications: Betoptic, and/or Trusopt, and/or Xalatan and 2 patients required 1 medication. After antiglaucoma medications mean IOP was 15.2 mmHg (range from 12 to 18 mmHg). CONCLUSION: The results of therapy for glaucoma associated with the Sturge-Weber syndrome are often disappointing.     

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

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, a complete success was defined as IOP of between 6 to 21 mm Hg without medication, qualified success as IOP between 6 to 21 mm Hg with one or more medication, and failure as a sustained IOP of >21 mm Hg or <6 mm Hg 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 to 22 months), IOP was reduced from a mean of 28.0 +/- 11.5 mm Hg to 15.2 +/- 6.0 mm Hg postoperatively (P <.0001), whereas the number of antiglaucoma medications decreased from a mean of 2.4 +/- 1.4 to.3 +/-.7 (P <.0001) at last follow-up. Overall, there were 24 eyes (75%) that were classified as complete successes, 4 eyes (12.5%) that were qualified successes, and 4 eyes that failed (12.5%). Twenty-three eyes (72%) had improvement of visual acuity, while only one eye had a loss of more than 1 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%). CONCLUSION: 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.     

Impact of intraocular pressure after filtration surgery on visual field progression in primary open-angle glaucoma

PURPOSE: To compare visual field progression after trabeculectomy in eyes showing a postoperative intraocular pressure (IOP) less than or equal to 16 mmHg and eyes with an IOP of 17 to 21 mmHg. METHODS: A retrospective cohort study design was used. A total of 101 eyes of 101 consecutive patients undergoing trabeculectomy for primary open-angle glaucoma (POAG) with a postoperative IOP less than or equal to 21 mmHg were divided into two groups: Group 1 included eyes showing a postoperative IOP less than or equal to 16 mmHg at all visits and Group 2 included eyes with a postoperative IOP between 17 and 21 mmHg. In turn, each of these groups was divided into two subgroups according to whether treatment was required for IOP control. Glaucomatous visual field control during follow-up was compared between the subject groups. RESULTS: Kaplan-Meier analysis revealed glaucomatous visual field control in 98.53% of the eyes in Group 1 and 89.06% of those in Group 2 at 5 years, the difference between the groups being significant. CONCLUSIONS: Glaucomatous disease progression is less frequent when IOP is less than or equal to 16 mmHg in all the follow-up visits after trabeculectomy. The results indicate a definite benefit of low IOP in visual field control.