Uneventful Phacoemulsification after Trabeculectomy in Pseudoexfoliation Glaucoma versus Primary Open-Angle Glaucoma. 2023

Hatice Tekcan, and Mehmet Serhat Mangan, and Serhat İmamoglu
Ophthalmology Department, Health Sciences University Turkey, Haydarpaşa Numune Research and Training Hospital, Istanbul, Turkey.

BACKGROUND Conflicting results have been reported on phacoemulsification in the filtered eyes with open-angle glaucoma. In this study, we aim to compare the effect of phacoemulsification after trabeculectomy between pseudoexfoliation glaucoma (XFG) and primary open-angle glaucoma (POAG). METHODS Consecutive patients with XFG and POAG who underwent uneventful phacoemulsification after trabeculectomy with 5-fluorouracil (TRAB-PHACO group) were reviewed retrospectively and matched to patients who underwent trabeculectomy only (TRAB group). Comparisons were performed for IOP, medication numbers, and success rates. Surgical failure was defined as IOP >21 mm Hg or IOP ≤21 mm Hg with additional medication or glaucoma surgery. Survival analysis was investigated by Kaplan-Meier test and the factors influencing final success by multivariate logistic regression analysis. RESULTS The records of 204 patients were reviewed. In XFG, when compared with the baseline, increase in IOP became statistically significant at the at 24-month visit in the TRAB-PHACO group (p = 0.002), at the 6-month visit (p = 0.001) in the TRAB group and remained so throughout the follow-up. In the TRAB-PHACO group, increase of glaucoma medications was statistically significant only at the last visit (p = 0.001) in XFG, at the 6-month visit (p = 0.02) in POAG and remained so throughout the follow-up. Two glaucoma types did not differ statistically from one another in terms of survival analysis. In the TRAB group, the additional glaucoma surgery was more common in XFG compared to POAG (p = 0.02). The trabeculectomy failure after phacoemulsification was related with an IOP spike >25 mm Hg at postoperative first 24h (p = 0.04). CONCLUSIONS In the filtered eyes with XFG, uneventful phacoemulsification may delay time-related worsening in IOP control and may decrease the additional glaucoma surgery need.

UI MeSH Term Description Entries
D007429 Intraocular Pressure The pressure of the fluids in the eye. Ocular Tension,Intraocular Pressures,Ocular Tensions,Pressure, Intraocular,Pressures, Intraocular,Tension, Ocular,Tensions, Ocular
D005901 Glaucoma An ocular disease, occurring in many forms, having as its primary characteristics an unstable or a sustained increase in the intraocular pressure which the eye cannot withstand without damage to its structure or impairment of its function. The consequences of the increased pressure may be manifested in a variety of symptoms, depending upon type and severity, such as excavation of the optic disk, hardness of the eyeball, corneal anesthesia, reduced visual acuity, seeing of colored halos around lights, disturbed dark adaptation, visual field defects, and headaches. (Dictionary of Visual Science, 4th ed) Glaucomas
D005902 Glaucoma, Open-Angle Glaucoma in which the angle of the anterior chamber is open and the trabecular meshwork does not encroach on the base of the iris. Glaucoma Simplex,Glaucoma, Pigmentary,Glaucoma, Simple,Open-Angle Glaucoma,Chronic Primary Open Angle Glaucoma,Glaucoma, Compensated,Glaucoma, Compensative,Glaucoma, Open Angle,Glaucoma, Primary Open Angle,Glaucoma, Secondary Open Angle,Primary Open Angle Glaucoma,Secondary Open Angle Glaucoma,Compensated Glaucoma,Compensative Glaucoma,Open Angle Glaucoma,Open Angle Glaucomas,Open-Angle Glaucomas,Pigmentary Glaucoma,Simple Glaucoma,Simplex, Glaucoma,Simplices, Glaucoma
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012189 Retrospective Studies Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons. Retrospective Study,Studies, Retrospective,Study, Retrospective
D014130 Trabeculectomy Any surgical procedure for treatment of glaucoma by means of puncture or reshaping of the trabecular meshwork. It includes goniotomy, trabeculectomy, and laser perforation. Goniotomy,Trabeculoplasty,Trabeculotomy,Goniotomies,Trabeculectomies,Trabeculoplasties,Trabeculotomies
D016896 Treatment Outcome Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series. Rehabilitation Outcome,Treatment Effectiveness,Clinical Effectiveness,Clinical Efficacy,Patient-Relevant Outcome,Treatment Efficacy,Effectiveness, Clinical,Effectiveness, Treatment,Efficacy, Clinical,Efficacy, Treatment,Outcome, Patient-Relevant,Outcome, Rehabilitation,Outcome, Treatment,Outcomes, Patient-Relevant,Patient Relevant Outcome,Patient-Relevant Outcomes
D017889 Exfoliation Syndrome The deposition of flaky, translucent fibrillar material most conspicuous on the anterior lens capsule and pupillary margin but also in both surfaces of the iris, the zonules, trabecular meshwork, ciliary body, corneal endothelium, and orbital blood vessels. It sometimes forms a membrane on the anterior iris surface. Exfoliation refers to the shedding of pigment by the iris. (Newell, Ophthalmology, 7th ed, p380) Glaucoma Capsulare,Pseudoexfoliation Syndrome,Exfoliation Glaucoma,Exfoliative Syndrome,Pseudo-Exfoliation Syndrome,Pseudoexfoliation Of The Lens,Exfoliation Syndromes,Exfoliative Syndromes,Pseudo Exfoliation Syndrome,Pseudo-Exfoliation Syndromes,Pseudoexfoliation Syndromes,Syndrome, Exfoliation,Syndrome, Exfoliative,Syndrome, Pseudo-Exfoliation,Syndrome, Pseudoexfoliation,Syndromes, Exfoliation,Syndromes, Exfoliative,Syndromes, Pseudo-Exfoliation,Syndromes, Pseudoexfoliation
D018918 Phacoemulsification A procedure for removal of the crystalline lens in cataract surgery in which an anterior capsulectomy is performed by means of a needle inserted through a small incision at the temporal limbus, allowing the lens contents to fall through the dilated pupil into the anterior chamber where they are broken up by the use of ultrasound and aspirated out of the eye through the incision. (Cline, et al., Dictionary of Visual Science, 4th ed & In Focus 1993;1(1):1) Phacoemulsifications

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