To stratify the outcomes of phacoemulsification combined with trabectome surgery using a new glaucoma severity index.
This is a retrospective, observational cohort study that included open angle glaucoma patients with visually significant cataract that had phacoemulsification combined with trabectome surgery. Exclusion criteria were follow-up less than 12 months, any other surgeries or diagnosis of neovascular or active uveitic glaucoma. Patients were stratified into four groups according to the Glaucoma Index (GI) that incorporated preoperative intraocular pressure (IOP), number of medications and visual field status. The primary outcome measures were IOP reduction and the success rate at 12 months. We examined the relationship between GI group and IOP and medications at one year with a linear regression analysis and survival with log-rank testing.
Of 1374 patients, a total of 498 cases with 12 month follow-up were included in the study after applying the exclusion criteria. At one year, IOP of GI groups 1 through 4 was reduced by 2.9 ± 4.4, 3.6 ± 5.0, 3.9 ± 5.3, and 9.2 ± 7.6 mmHg for. Individuals in the next higher GI group had a 1.69 ± 0.2 mmHg larger IOP decrease. The success rate was 98%, 93%, 96% and 88% at one year for GI groups 1 to 4 (p < 0.05).
A substantial IOP reduction was seen in subjects with more advanced glaucoma suggesting that the trabecular meshwork is the primary impediment to outflow and its ablation benefits those eyes relatively more than in mild glaucoma. A larger IOP reduction can be expected in individuals with a higher GI group that indicates a clinically more challenging glaucoma.
Riaz Y, de Silva SR, Evans JR. Manual small incision cataract surgery (MSICS) with posterior chamber intraocular lens versus phacoemulsification with posterior chamber intraocular lens for age-related cataract. Cochrane Database Syst Rev. 2013;10:CD008813.
Kaplowitz K, Bussel II, Honkanen R, Schuman JS, Loewen NA. Review and meta-analysis of ab-interno trabeculectomy outcomes. Br J Ophthalmol. 2016; doi:10.1136/bjophthalmol-2015-307131.
Parikh HA BSc, Roy P MD, Dhaliwal A BSc, Kaplowitz KB MD, Loewen NA MD. Trabectome Patient Selection, Preparation, Technique, Management, and Outcomes. US Ophthalmic Review. 2015;08: 103.
Stamper RL. CHAPTER 3.7 – Clinical interpretation of gonioscopic findings. In: Stamper RL, Lieberman MF, Drake M V, editors. Becker-Shaffer’s Diagnosis and Therapy of the Glaucomas (Eighth Edition). Amsterdam: Mosby; 2009. pp. 78–90.
Poley BJ, Lindstrom RL, Samuelson TW, Schulze Jr R. Intraocular pressure reduction after phacoemulsification with intraocular lens implantation in glaucomatous and nonglaucomatous eyes: evaluation of a causal relationship between the natural lens and open-angle glaucoma. J Cataract Refract Surg. 2009;35:1946–55. CrossRefPubMed
Ocular Hypertension Treatment Study Group, European Glaucoma Prevention Study Group, Gordon MO, Torri V, Miglior S, Beiser JA, et al. Validated prediction model for the development of primary open-angle glaucoma in individuals with ocular hypertension. Ophthalmology. 2007;114:10–9. CrossRef
- Stratification of phaco-trabectome surgery results using a glaucoma severity index in a retrospective analysis
Ralitsa T. Loewen
Hardik A. Parikh
Igor I. Bussel
Nils A. Loewen
- BioMed Central