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Phacoemulsification with intraocular lens implantation after trabeculectomy
R Casson1, R Rahman, John F Salmon
1Nuffield Laboratory of Ophthalmology, Oxford University, England.
Journal of Glaucoma
|October 4, 2002
Summary
Phacoemulsification with intraocular lens (IOL) implantation after trabeculectomy may temporarily increase intraocular pressure (IOP). Long-term IOP control might be jeopardized in some patients, despite initial minimal effects.
Area of Science:
- Ophthalmology
- Glaucoma Surgery
- Cataract Surgery
Background:
- Trabeculectomy is a surgical procedure to lower intraocular pressure (IOP) in glaucoma patients.
- Phacoemulsification with intraocular lens (IOL) implantation is a common cataract surgery technique.
- The effect of subsequent cataract surgery on previously operated glaucoma eyes requires investigation.
Purpose of the Study:
- To evaluate the long-term intraocular pressure (IOP) control after phacoemulsification with IOL implantation in patients with a history of trabeculectomy.
- To compare IOP outcomes between patients undergoing cataract surgery post-trabeculectomy and those who only had trabeculectomy.
Main Methods:
- A retrospective matched cohort study comparing 28 patients (phaco group) who had phacoemulsification with IOL implantation at least 3 months post-trabeculectomy to 28 patients (trabeculectomy-only group).
- Intraocular pressure (IOP) was compared at 1 and 2 years post-operatively.
- Surgical success rates were analyzed using Kaplan-Meier survival analysis, defining "failure" as the need for additional glaucoma medication.
Main Results:
- Mean IOP was significantly higher in the phaco group at 1 year post-surgery (15.6 mmHg vs. 13.4 mmHg, p=0.025), but not statistically different at 2 years (15.3 mmHg vs. 14.3 mmHg, p=0.35).
- More patients in the phaco group (5/28) required additional topical medication by 2 years compared to the trabeculectomy-only group (1/28, p=0.089).
- Trabeculectomy-only group demonstrated significantly better IOP control when medication introduction was considered a failure.
Conclusions:
- Phacoemulsification with IOL implantation via a superior clear-corneal incision has minimal impact on mean IOP in patients with prior trabeculectomy.
- However, this procedure may compromise long-term intraocular pressure control in individual patients previously treated with trabeculectomy.
- Careful monitoring is advised for patients undergoing cataract surgery after glaucoma filtration surgery.