Phacoemulsification and intraocular lens implantation in eyes with open-angle glaucoma

PURPOSE: To study the effect of phacoemulsification and intraocular lens implantation (PHACO IOL) on intraocular pressure (IOP) and glaucoma medication in open-angle glaucoma (OAG) eyes. METHODS: 38 open-angle glaucoma (OAG) eyes with cataract underwent phacoemulsification and intraocular lens implantation (PHACO IOL) performed by one surgeon (RJU). None of the patients had prior intraocular surgery. Surgery was performed by scleral incision on 37% and by clear corneal incision on 63%. Patients were re-examined on the first postoperative day, after one week, 4 months, and in 29 cases 1-3.7 (mean 2.8) years after the operation. RESULTS: The mean preoperative IOP was 18.4+/-3.3 mmHg with a mean of 1.7 glaucoma medications. On the first postoperative day, the mean IOP rose to 28.2 +/- 12.5 mmHg. IOP > or = 30 mmHg occurred in 39.5% of the eyes. After one week, IOP had returned to the preoperative level. After 4 months, IOP had further decreased to 16.1 +/- 3.8 mmHg (p = 0.0027). After a mean follow-up of 1-3.7 (mean 2.8) years, the average postoperative IOP was 15.1 +/- 2.9 mmHg, being significantly (p = 0.001) lower than the preoperative IOP with 86% of the patients having a mean of 1.6 drugs on average. The type of incision (scleral vs. corneal) did not affect the postoperative IOP level. Using the criteria of Bigger and Becker (1971) the long-term IOP control after PHACO-IOL surgery was improved or unchanged in 86% and worse in 14% of the preoperatively well-controlled OAG eyes. CONCLUSIONS: In OAG eyes PHACO IOL is associated with a significant decrease in IOP with less medication up to 1-3.7 (mean 2.8) years.     

Efficacy of glaucoma filtration surgery in pseudophakic patients with or without conjunctival scarring

PURPOSE: To analyze the intraocular pressure (IOP), glaucoma medication requirements, and visual acuity after glaucoma filtration surgery in pseudophakic eyes. SETTING: Private practice, Boston, Massachusetts, USA. METHODS: The results of glaucoma filtration surgery in 47 eyes of 40 pseudophakic patients with a minimum follow-up of 1 year were retrospectively reviewed. Eyes with previously surgically manipulated conjunctiva in the area of filtration were compared to eyes without previous manipulation. RESULTS: Preoperatively, the mean IOP was 25 mm Hg +/- 7.3 (SD); mean number of glaucoma medications, 3.3 +/- 1.0; and mean logMAR visual acuity, 0.41 +/- 0.38. At the final follow-up visit (mean 36.5 +/- 31.5 months), the respective means were 13.6 +/- 6.6 mm Hg (P<.001), 0.9 +/- 1.4 (P<.001), and 0.46 +/- 0.43 (P=.53). The mean postoperative IOP, glaucoma medication requirements, and visual acuity at the final follow-up in eyes with virgin conjunctiva and eyes with previously manipulated conjunctiva were, respectively, as follows: IOP, 12.5 +/- 3.2 mm Hg and 14.1 +/- 7.6 mm Hg (P=.52); medications, 1.1 +/- 1.3 and 0.9 +/- 1.4 (P=.66); and logMAR acuity, 0.6 +/- 0.52 and 0.4 +/- 0.39 (P=.23). CONCLUSIONS: Glaucoma filtration surgery in pseudophakic eyes significantly improved IOP and reduced glaucoma medication requirements while maintaining stability of vision. There were no statistically significant differences in final IOP, glaucoma medication requirements, or visual acuity between eyes with virgin conjunctiva and eyes with previously surgically manipulated conjunctiva.     

Long-term effect of phacoemulsification on intraocular pressure after trabeculectomy

PURPOSE: To evaluate the effect of temporal clear corneal phacoemulsification on intraocular pressure (IOP) in eyes that have had trabeculectomy. SETTING: Department of Ophthalmology, University of Vienna, Vienna, Austria. METHODS: This retrospective study evaluated the IOP in 48 eyes (35 patients) that had temporal clear corneal phacoemulsification after trabeculectomy. The mean interval between trabeculectomy and phacoemulsification was 27 months +/- 21 (SD) and the mean follow-up after phacoemulsification, 23 +/- 12 months. Intraocular pressure and antiglaucoma therapy before cataract surgery and at the end of follow-up were evaluated. For statistical analysis, the paired t test, Wilcoxon test, and chi-square test were used. RESULTS: Thirty-five eyes (73%) preoperatively and 25 eyes (52%) postoperatively were controlled (IOP < 22 mm Hg) without antiglaucoma therapy. The difference was statistically significant (P =.04, chi-square test). At the end of follow-up, the increase in mean IOP (1.6 mm Hg) and in mean number of antiglaucoma medications (0.4) was statistically significant (P =.002 and P =.05, respectively). CONCLUSIONS: Temporal clear corneal phacoemulsification after trabeculectomy was followed by a slight but statistically significant increase in IOP and the need for antiglaucoma medication after 2 years. However, the impairment in IOP control is comparable to that in the natural course of trabeculectomy.     

Effects of pupil stretch technique during phacoemulsification on postoperative vision, intraocular pressure, and inflammation

PURPOSE: To determine whether pupil stretch during phacoemulsification affects postoperative best corrected visual acuity (BCVA), intraocular pressure (IOP), and inflammation compared with results in patients without pupil stretch. METHODS: A retrospective analysis of 115 eyes that had pupil stretch during phacoemulsification (study group) and 125 eyes without pupil stretch (control group) was performed with a minimum of 12 months follow-up. Single-factor analysis of variance and 2-tailed homoscedastic t tests were used for statistical analysis. RESULTS: The mean preoperative logMAR equivalent BCVA was 0.5 +/- 0.3 (SD) in the study group and 0.6 +/- 0.4 in the control group. The mean preoperative IOP was 16.2 +/- 4.1 mm Hg in the study group and 16.0 +/- 3.5 mm Hg (control group). There was no statistically significant difference at postoperative follow-up of 1 year in BCVA or IOP between the 2 groups (1 year BCVA 0.2 +/- 0.2 [study group], 0.2 +/- 0.2 [control group] [P<.1]; IOP 14.5 +/- 3.5 mm Hg and 14.7 +/- 3.3 mm Hg, respectively [P<.7]). There was no significant difference in the number of glaucoma medications required for glaucoma patients preoperatively and postoperatively between the 2 groups (P<.5). Complications were rare, and there was no significant difference in the complications (ie, iritis, hyphema, cystoid macular edema, epiretinal membrane formation) between the 2 groups at 1 year. CONCLUSION: Pupil stretch during phacoemulsification was not associated with a statistically significant difference in BCVA, IOP, inflammation, or other complications postoperatively compared with results in the control group without pupil stretch.     

Intracorneal hematoma after canaloplasty and clear cornea phacoemulsification: surgical management

Purpose. This is a case report of intracorneal hematoma after canaloplasty and clear cornea phacoemulsification. Methods. A 75-year-old woman presented with primary open angle glaucoma and visually significant cataract. Canaloplasty and clear corneal phacoemulsification were performed. Postoperatively she had an intracorneal hematoma, which was removed through a clear corneal tunnel. Results. Preoperative best-corrected visual acuity (BCVA) was 20/40 in the right eye and mean intraocular pressure (IOP) was 20 mmHg. Uneventful canaloplasty, clear corneal phacoemulsification, and implantation of a posterior chamber intraocular lens were performed. One day after the operation, BCVA was 20/400 in the right eye. The IOP was 8 mmHg. Anterior segment examination revealed a nasally located intrastromal hematoma between corneal stroma and Descemet membrane. The intracorneal hematoma was removed through a clear corneal tunnel. Six months postoperatively, BCVA was 20/25 in the right eye. The IOP with one medication was 17 mmHg. Conclusions. This operation was a minimally invasive technique to remove intrastromal hematocornea after viscocanaloplasty.     

Long-term changes in intraocular pressure after clear corneal phacoemulsification: normal patients versus glaucoma suspect and glaucoma patients.

PURPOSE: To compare the effects of clear corneal phacoemulsification on intraocular pressure (IOP) in patients without glaucoma, glaucoma suspects, and patients with glaucoma. SETTING: Urban, multisubspecialty private practice. METHODS: A retrospective analysis of patients who had clear corneal phacoemulsification with a minimum of 12 months follow-up was performed. The patients were divided into 3 groups: no glaucoma (NG), glaucoma suspects (GS), and glaucoma (GG). None had a history of prior surgery. Glaucoma suspects included patients with elevated IOPs, abnormal discs, pseudoexfoliation syndrome, or pigment dispersion syndrome on no medications and with no field defects. Glaucoma patients had received only medical treatment. Two-tailed, homoscedastic t tests were used for statistical analysis. RESULTS: There were 143 patients (164 eyes) in the NG group, 65 (75) in the GS group, and 61 (71) in the GG group. The mean preoperative IOP was 16.42 mm Hg +/- 2.77 (SD), 17.59 +/- 4.15 mm Hg, and 16.97 +/- 4.86 mm Hg in the 3 groups, respectively. At 1 year, the mean IOP was lower in all groups: 14.37 +/- 2.97 mm Hg, 15.68 +/- 3.38 mm Hg, and 15.86 +/- 4.00 mm Hg, respectively. The change was statistically significant in the NG and GS groups. Glaucoma patients showed a statistically significant reduction in the number of glaucoma medications postoperatively. CONCLUSION: Clear corneal phacoemulsification was associated with a statistically significant long-term reduction in IOP.     

Effect of temporal clear corneal phacoemulsification on intraocular pressure in eyes with prior Ahmed glaucoma valve insertion

PURPOSE: To evaluate the effect of temporal clear corneal phacoemulsification on intraocular pressure (IOP) in eyes after Ahmed glaucoma valve insertion. SETTING: Department of Ophthalmology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea. METHODS: The files of 13 patients who received phacoemulsification after Ahmed glaucoma valve insertion were reviewed in this retrospective case series. Visual acuity, IOP, and the number of glaucoma medications before phacoemulsification were used as a baseline for comparison with the values at various follow-up intervals. RESULTS: The mean IOP before phacoemulsification was 15.1 mm Hg +/- 3.6 (SD). Postoperatively, it was 12.8 +/- 4.5 mm Hg, 13.1 +/- 3.6 mm Hg, 16.4 +/- 5.2 mm Hg, 15.8 +/- 4.0 mm Hg, 16.1 +/- 3.9 mm Hg, 15.3 +/- 4.1 mm Hg, and 15.2 +/- 3.4 mm Hg at 1 day after 1 week, at 1, 2, 6, and 12 months, and at last visits, respectively. The mean IOP did not differ significantly from the prephacoemulsification value at any follow-up. The number of glaucoma medications increased significantly after phacoemulsification (P = .031), and 6 of 13 eyes required additional glaucoma medication because of IOP elevation at approximately 1 month. CONCLUSIONS: Temporal clear corneal phacoemulsification did not increase IOP significantly in eyes with prior Ahmed glaucoma valve insertion. However, some eyes experienced an IOP elevation 1 month after phacoemulsification and required glaucoma medication.     

Comparison of 1-site versus 2-site phacotrabeculectomy

PURPOSE: To compare the results of 1-site versus 2-site combination glaucoma filtration and phacoemulsification surgery with respect to visual acuity, intraocular pressure (IOP), and glaucoma medication requirements via a case control study. METHODS: Results of 2-site phacotrabeculectomy surgery in 64 eyes of 59 patients were retrospectively reviewed with a minimum follow-up of 1 year. The 2-site procedures were compared with a randomly chosen control group of 71 1-site phacotrabeculectomies performed by the same surgeon. RESULTS: The presurgical visual acuity, IOP, and glaucoma medication requirements did not differ significantly between the 2 groups. Mean final postoperative results at 1 year for 2-site versus 1-site eyes, respectively, were visual acuity 0.32 +/- 0.353 (SD) and 0.32 +/- 0.37 (P = .99), IOP 15.0 +/- 3.7 mm Hg and 15.1 +/- 6.3 mm Hg (P = .97), and glaucoma medication requirements 0.43 +/- 0.90 and 0.61 +/- 1.1 (P = .52). CONCLUSION: There was no statistically significant difference in the final visual acuity, IOP, or glaucoma medication requirements between the 2-site and 1-site groups.     

Evaluation of intraocular pressure in the immediate period after phacoemulsification

PURPOSE: To determine the incidence of hypotony or intraocular pressure (IOP) spikes in the early period after clear corneal phacoemulsification in normal and glaucomatous eyes. SETTING: Ambulatory surgical center. METHODS: This retrospective analysis comprised 112 eyes that had clear corneal phacoemulsification. Postoperative IOP measurements were collected 30 minutes, 1 day, and 1 month after surgery. RESULTS: Twenty-three eyes had an IOP of 5 mm Hg or below 30 minutes postoperatively. The IOP at 30 minutes was lower than at 1 day in both the normal and the glaucoma group. The mean IOP in the normal group was 10.0 mm Hg +/- 4.3 (SD) at 30 minutes and 16.9 +/- 4.4 mm Hg at 1 day (P < or = .005). The means in the glaucoma group were 9.6 +/- 3.9 mm Hg and 16.9 +/- 5.7 mm Hg, respectively (P < or = .0002). The IOPs at 30 minutes and 1 day were not significantly different between the 2 groups. CONCLUSIONS: A significant percentage of eyes having clear corneal phacoemulsification had an IOP of 5 mm Hg or less 30 minutes after surgery. Even though there were no postoperative complications from hypotony and there was a relative absence of significant IOP elevation 1 day postoperatively, the frequency of low IOP at 30 minutes suggests that consideration be given to leaving postoperative eyes with a higher IOP at the completion of phacoemulsification rather than with the estimated 10 mm Hg tactile IOP strived for in this study.     

Efficacy and safety of deep sclerectomy and phacoemulsification and deep sclerectomy in clinical material of Military Health Service Institute--yearly observations

PURPOSE: Comparison of the effectiveness of nonpenetrated deep sclerectomy (DS) as the only procedure in relation to operation combined with phacoemulsification (FDS) in treatment of patients with open-angle glaucoma based on yearly observation. MATERIAL AND METHODS: 67 eyes with open-angle glaucoma were retrospectively analyzed. Applying layer-systematic criteria 21 eyes after deep sclerectomy with scleral implant (SKGEL/Corneal or T-flux/I-Tech) were selected into group I (DS implant) and 23 eyes after phacoemulsification with simultaneously performed deep sclerectomy and scleral implants were selected into group II (FDS implant). In control studies best corrected visual acuity (BCVA), intraocular pressure (IOP), anterior chamber and fundus, were examined. Postoperative complications and applied procedures were analyzed especially controlling hypotensive effect (goniopuncture, antimetabolites), as well as number of glaucoma medications used. Tests were performed in 1 and 7 days after surgery, and later after 1, 3, 6, 12 months. Statistically test U Mann-Whitney was used as well as pair sequence Wilcoxon test. Survival analysis was done with Kaplan-Meier method with the use of log rank test. RESULTS: After 360 days of observation mean values of IOP in group I was 14.3 +/- 3.6 mmHg, and in group II--12.9 +/- 3.0 mmHg. It was a decrease of mean IOP by 29.6% (p = .000) and 41.4% (p = .000) in comparison to preoperative IOP in particular groups. In both groups fewer glaucoma medications were used after surgery and the results were statistically significant (p < .05). As a complete success rate was considered IOP of < or =18 mmHg without glaucoma medications, and qualified success rate was IOP of < or =18 mmHg without medications or with the most of two glaucoma medications. Complete and qualified success rate were achieved respectively in group I (72.6% and 88.4%) and in group II (74.3% and 86.9%) at the end of observation. In the entire observation there were no statistically significant differences between group I and 2 (p > .05). After 360 days of observation there was no statistically significant difference between mean BCVA in group I and II (p > .05). CONCLUSIONS: DS with scleral implant performed as a single procedure or FDS is effective treatment in open-angle glaucoma.     

The outcome of phacoemulsification in eyes after filtering glaucoma surgery

BACKGROUND: Our aim was to evaluate the outcome of phacoemulsification in eyes after filtering glaucoma surgery. PATIENTS AND METHODS: Thirty eyes of 30 patients with different forms of glaucoma in which phacoemulsification after filtering glaucoma surgery was done were included in this retrospective study. Intraocular pressure (IOP) was measured before and one week, 1, 3, 6, 12, 18, 24, 30, 36 and 42 months after phacoemulsification. The best corrected visual acuity (BCVA) and the number of antiglaucoma medications before phacoemulsification and at the end of follow-up were evaluated. Partial failure of IOP control was defined as the need for an increased number of antiglaucoma medications to maintain IOP < 21 mmHg or prevent a progression of visual field or optic disc damage. Complete failure of IOP control was defined as an IOP > 21 mmHg with an additional number of antiglaucoma medications or a progression of visual field or optic disc damage requiring filtering surgery. RESULTS: The mean interval between filtration surgery and phacoemulsification was 5.8 years (SD 3.8) and the mean follow-up after phacoemulsification was 23.4 months (SD 11.4). There were no differences between the mean IOP before and after phacoemulsification during the entire follow-up period (p > 0.05). The mean preoperative BCVA was 0.30 (SD 0.2), improving to a mean of 0.72 (SD 0.3) postoperatively at the end of follow-up (p < 0.0001). The mean number of antiglaucoma medications before phacoemulsification was 1.2 (SD 1.2), increasing after phacoemulsification to 1.5 (SD 1.2) at the end of follow-up (p > 0.05). In 9 eyes a partial failure of IOP control was assessed, so according to the Kaplan-Meier survival analysis the success rate after 12 months was 72 % and after 42 months 67 %. In 3 eyes a complete failure of IOP control was assessed, thus according to the Kaplan-Meier survival analysis the success rate after 22 months was 93 % and after 42 months 77 %. CONCLUSION: Phacoemulsification in eyes after filtering glaucoma surgery resulted in a stable IOP, a non-significant increase in the number of antiglaucoma medications and a significantly improved BCVA.     

Circumferential viscodilation and tensioning of Schlemm canal (canaloplasty) with temporal clear corneal phacoemulsification cataract surgery for open-angle glaucoma and visually significant cataract: one-year results

PURPOSE: To evaluate the safety and efficacy of circumferential viscodilation and tensioning of the inner wall of Schlemm canal, a new nonpenetrating surgical procedure (canaloplasty) to treat open-angle glaucoma (OAG), combined with clear corneal phacoemulsification and posterior chamber intraocular lens (IOL) implantation. SETTING: Multicenter surgical sites. METHODS: This international multicenter prospective study comprised adult patients with OAG having combined glaucoma and cataract surgery. Patients with qualifying treated preoperative intraocular pressure (IOP) of at least 21 mm Hg or higher and open angles were eligible. Evaluation was performed at baseline and 1 day, 1 week, and 1, 3, 6, and 12 months postoperatively. Intraoperative and postoperative high-resolution ultrasound imaging was used to assess Schlemm canal and anterior segment angle morphology, including distension of the trabecular meshwork due to the tensioning suture. RESULTS: Data from 54 eyes that had combined glaucoma and cataract surgery performed by 11 surgeons at 9 study sites were analyzed for this interim analysis. The mean baseline IOP was 24.4 mm Hg+/-6.1 (SD) with a mean of 1.5+/-1.0 medications per eye. In all eyes, the mean postoperative IOP was 13.6+/-3.8 mm Hg at 1 month, 14.2+/-3.6 mm Hg at 3 months, 13.0+/-2.9 mm Hg at 6 months, and 13.7+/-4.4 mm Hg at 12 months. Medication use dropped to a mean of 0.2+/-0.4 per patient at 12 months. Surgical complications were reported in 5 eyes (9.3%) and included hyphema (n=3, 5.6%), Descemet tear (n=1, 1.9%), and iris prolapse (n=1, 1.9%). Transient IOP elevation of more than 30 mm Hg was observed in 4 eyes (7.3%) 1 day postoperatively. CONCLUSION: Circumferential viscodilation and tensioning of Schlemm canal combined with clear corneal phacoemulsification and posterior chamber IOL implantation was a safe and effective procedure to reduce IOP in adult patients with OAG.     

Phacoemulsification in eyes with functioning filtering blebs: a prospective study

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 1 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 (+/- standard deviation) 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 1, 6, 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 6 months and 1 and 2 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.     

单穿刺双切口青光眼白内障联合手术的临床观察

目的：探讨单穿刺双切口青光眼白内障联合手术的方法和效果。 方法：对28例30眼青光眼合并白内障患者行改良的单穿刺双切口青光眼白内障联合手术。常规白内障超声乳化手术（10∶00位透明角膜切口）后,11∶00~1∶00位距角膜缘后2mm处剪开球结膜及Tenon囊,3mm穿刺刀于角膜缘后2 mm穿刺入前房,作一3 mm宽、1/3~1/4巩膜厚度的巩膜隧道,伸入小梁咬切器,咬除3块约1mm×1mm大小小梁组织。术后随访3~6 mo观察视力、眼压、滤过泡形态（ OCT检测）及并发症的情况。 结果：术后1wk,视力〈0.1者3眼,0.1~者6眼,0.3~者13眼,0.6~0.8者8眼;1眼发生恶性青光眼,8眼早期角膜水肿及瞳孔区轻微纤维素渗出;30眼均为功能性滤过泡（Ⅰ型、Ⅱ型滤过泡）, OCT显示滤过口通畅;随访3~6mo,28眼眼压在正常范围内,2眼出现眼压控制不良。结论：单穿刺双切口青光眼白内障联合手术简单易行,手术效果良好,术后并发症少,值得推广。     

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.     

Three and five year changes in intraocular pressures after clear corneal phacoemulsification in open angle glaucoma patients, glaucoma suspects, and normal patients

PURPOSE: This study evaluates the change in intraocular pressure (IOP) and glaucoma medication requirements after clear corneal phacoemulsification in open angle glaucoma patients, glaucoma suspects, and normal patients at 3 years and last follow-up (mean 5 y). PATIENTS AND METHODS: This study represents a retrospective analysis of patients who had clear corneal phacoemulsification and at least 3 years of follow-up. The patients were classified into 3 groups: glaucoma (G), glaucoma suspects (GS), and no glaucoma (NG). No patient had a history of previous intraocular surgery. Single factor analysis of variance, Fisher exact tests, 2-tailed paired Student t tests and Kaplan-Meier analysis were applied. RESULTS: Forty-eight patients (55 eyes) in the glaucoma group, 41 patients (44 eyes) in the GS group, and 59 patients (59 eyes) in the NG group met the above criteria. At 3 years follow-up IOP was significantly decreased in all groups; (G) group decreased 1.4+/-3.3 mm Hg (P = 0.0025), GS 1.4+/-4.2 mm Hg (P = 0.004), and NG 1.7+/-3.1 mm Hg (P = 0.0005). At the final follow-up visit (mean near 5 y for all groups) the IOP was significantly decreased in all groups, (G) group 1.8+/-3.5 mm Hg (P = 0.005), GS 1.3+/-3.7 mm Hg (P = 0.025), and NG 1.5+/-2.5 mm Hg (P < 0.0001). The number of preoperative and postoperative glaucoma medications in the (G) group did not show any significant change at 3 and 5 years (P = 0.36, P = 0.87). Kaplan-Meier analysis shows that at 3 years, 85% of the (G) group, 81% of GS, and 90% of the NG had IOPs less than or equal to their preoperative IOP, with the same number of glaucoma medications or less. At 5 years the percentages were 76%, 79%, and 85%, respectively. CONCLUSIONS: This study demonstrates that cataract removal by clear cornea phacoemulsification in glaucoma patients, glaucoma suspects, and normal patients results in a small but significant decrease in IOP that is sustained at 3 years and a mean of 5 years in all groups. This study does not imply that cataract removal by phacoemulsification is a substitute for a combined procedure but may be an appropriate procedure for certain patients based on medication requirements and extent of optic nerve damage.     

Outcomes of phacoemulsification in fellow eyes of patients with unilateral pseudoexfoliation: single-surgeon series

PURPOSE: To compare intraoperative and postoperative complications, best corrected visual acuity, intraocular pressure (IOP), and glaucoma medication requirements between eyes with clinically apparent pseudoexfoliation (PEX) and fellow eyes without PEX in patients having bilateral cataract surgery. SETTING: Private practice, Boston, Massachusetts, USA. METHODS: This retrospective study comprised 1000 consecutive patients who had cataract surgery performed by the same surgeon. Of the 1000 patients, 137 had unilateral PEX and bilateral cataract surgery. Patients with previous or concurrent glaucoma surgery were eliminated from the study. Two-way analysis of variance and Tukey post hoc tests were used for statistical analysis. RESULTS: Complications were few, with no significant differences between the 2 groups intraoperatively (zonule instability) or postoperatively (corneal edema, cystoid macular edema, intraocular lens decentration). Both groups had improved visual acuity, with no statistically significant between- group difference in acuity at 1 year. Both groups had decreased IOP postoperatively, although the eyes with PEX had a significantly greater mean Delta IOP than the fellow eyes without PEX (P<.016). The PEX group required more glaucoma medications overall (P<.003) and needed more glaucoma medications at 3 to 5 years than preoperatively; the medication requirement in the fellow-eye group remained stable. CONCLUSIONS: The presence of clinically apparent PEX had an impact on IOP reduction and glaucoma medication requirements. There were no differences in intraoperative or postoperative complications between eyes with PEX and fellow eyes without PEX.     

颞侧巩膜手法小切口白内障摘出术治疗青光眼术后白内障

目的：探讨青光眼滤过术后行小切口白内障的手术方法及疗效。方法：采用颞侧巩膜隧道切口,对50例50眼青光眼术后白内障患者行小切口白内障囊外摘出联合人工晶状体植入术,术后观察视力、眼压、角膜曲率、滤过泡等情况。结果：随访3～12mo,所有患者视力较术前均有提高。眼压与术前基本相同,滤过泡形态无改变。术后1wk角膜曲率为0.75～1.25D,在术后3mo恢复到术前状态。未见明显并发症。结论：经颞侧巩膜手法小切口白内障摘出术是治疗青光眼术后白内障的有效方法。     

超声乳化白内障吸除折叠式人工晶状体植入联合青光眼小梁切除术

目的 评价３．５ｍｍ小切口超声乳化白内障吸除折叠式人工晶状体（ｉｎｔｒａｏｃｕｌａｒ ｌｅｎｓ,ＩＯＬ）植入联合小梁切除术（三联手术）的安全 及有效性,并比较常规巩膜瓣和隧道巩膜瓣２种小切口三联手术的效果。方法 采用上方３．５ｍｍ常规巩膜瓣或隧道巩膜瓣切口对４２例（４４只眼）白内障合并联手术的效果。方法 采用上方３．５ｍｍ常规巩膜瓣或隧道巩膜瓣切口对４２例（４４只眼）白内障合并青光眼患者行三联手术     

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.