Journal article
Long-term efficacy of combined phacoemulsification plus trabeculectomy versus phacoemulsification plus excimer laser trabeculotomy
Klinische Monatsblatter fur Augenheilkunde, Vol.234(4), pp.457-463
04/01/2017
DOI: 10.1055/s-0043-100291
PMID: 28264221
Abstract
Combined cataract and glaucoma procedures, and minimally-invasive glaucoma surgery in particular, have gained increasing interest over the past few years. The aim of this study was to compare the long-term efficacy of combined phaco-trabeculectomy (Phaco-Trab) and combined phacoemulsification plus excimer laser trabeculotomy (Phaco-ELT).
Retrospective, non-randomised, comparative, interventional case series of consecutive patients after Phaco-Trab and Phaco-ELT at the University Hospital of Zurich and the Talacker Eye Center Zurich in Switzerland. Inclusion criteria were diagnosis of glaucoma plus vision-impairing coexisting cataract. Primary outcome measures were change in intraocular pressure (IOP), number of anti-glaucoma drugs (AGDs), and best-corrected visual acuity (BCVA) 1 year and 4 years after the procedure. Secondary outcome measures were surgical complications and requirement of postoperative interventions. Success was defined based on the criteria of the Tube-versus-Trabeculectomy study.
Mean age was 76.1 ± 8.6 years (29.2 % males; 47.8 % right eyes). Phaco-Trab (n = 62) decreased median IOP from 22.8 to 13.0 at 1 year and to 14.0 mmHg at 4 years. AGDs were reduced from 2 drugs to 0 AGDs at 1 year and 4 years. Median BCVA improved from 0.2 logMAR to 0.0 logMAR at 1 year and 4 years. Phaco-ELT (n = 51) lowered median IOP from 19.0 to 15.0 at 1 year and to 14.0 mmHg (p = 0.002) at 4 years. AGDs were reduced from 2 drugs to 1 AGD at 1 year and 4 years (p = 0.002). BCVA improved from 0.4 logMAR to 0.1 logMAR after 1 year and 4 years. If not stated otherwise, all changes compared to baseline were highly significant (p < 0.001). No perioperative complications occurred; postoperative interventions were performed in 74 % of Phaco-Trab patients.
Both surgical procedures reduced IOP and AGDs and improved BCVA significantly and persistently during the entire follow-up period of 4 years with a good safety profile. This study validates Phaco-ELT as an option when post-operative target pressure in the mid-teens would be adequate, whereas Phaco-Trab would be the treatment of choice when IOP in the low teens is desired.
Details
- Title: Subtitle
- Long-term efficacy of combined phacoemulsification plus trabeculectomy versus phacoemulsification plus excimer laser trabeculotomy
- Creators
- M Töteberg-Harms - UniversityHospital Zurich, Department of Ophthalmology, Zurich, SwitzerlandJ Wachtl - University Hospital of ZurichC Schweier - Klinikum ChemnitzJ Funk - University Hospital of ZurichC Kniestedt - University Hospital of Zurich
- Resource Type
- Journal article
- Publication Details
- Klinische Monatsblatter fur Augenheilkunde, Vol.234(4), pp.457-463
- DOI
- 10.1055/s-0043-100291
- PMID
- 28264221
- ISSN
- 0023-2165
- eISSN
- 1439-3999
- Alternative title
- Langzeiterfolg von kombinierter Phakoemulsifikation plus Trabekulektomie im Vergleich zu Phakoemulsifikation plus Excimer-Laser-Trabekulotomie
- Language
- English
- Date published
- 04/01/2017
- Academic Unit
- Ophthalmology and Visual Sciences
- Record Identifier
- 9984696565602771
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