Abstract
PurposeTo determine the occurrence of intraoperative and postoperative complications up to three years after primary phacotrabeculectomy with intraoperative use of Mitomycin C (MMC) in primary open angle (POAG) and primary angle closure glaucoma (PACG) patients, and the effect of postoperative complications on surgical outcome.MethodsRetrospective review of 160 consecutive patients with POAG (n = 105) and PACG (n = 55), who underwent primary phacotrabeculectomy with MMC at the National University Hospital, Singapore, from January 1, 2008 to December 31, 2010. Data was collected using a standardized form that included patient demographic information, ocular characteristics and postoperative complications, including hypotony (defined as intraocular pressure < 6 mmHg), shallow anterior chamber (AC) and hyphema.ResultsThe mean age ± standard deviation (SD) of patients was 68.2 ± 8.2 years. No patient lost light perception during duration of follow-up. 77% of the postoperative complications occurred within the first month only. The commonest complications were hypotony (n = 41, 25.6%), hyphema (n = 16, 10.0%) and shallow AC (n = 16, 10.0%). Five patients (3.1%) required reoperation for their complications. Early hypotony (defined as hypotony < 30 days postoperatively) was an independent risk factor for surgical failure (hazard ratio [HR], 5.1; 95% CI, 1.6–16.2; p = 0.01). Hypotony with another complication was also a risk factor for surgical failure (p < 0.02).ConclusionsHypotony, hyphema and shallow AC were the commonest postoperative complications in POAG and PACG patients after phacotrabeculectomy with MMC. Most complications were transient and self-limiting. Early hypotony within the first month was a significant risk factor for surgical failure.
Highlights
Cataract and glaucoma are the top two causes of blindness in the world respectively and they frequently co-exist in the same eye [1]
Sequential cataract surgery is associated with increased risk of trabeculectomy failure which may be minimised by combined phacotrabeulectomy [6]
67 (25.6%) were excluded due to the following reasons: postoperative follow-up duration of less than one year (n = 32, 12.2%), preoperative Intraocular pressure (IOP) taken on less than three occasions (n = 16, 6.1%), previous intraocular operation/lasers except peripheral iridotomy performed such as laser trabeculoplasty, iridoplasty, retinal detachment surgery, pterygium surgery (n = 14, 5.3%), secondary glaucoma such as traumatic, neovascular, uveitic glaucoma (n = 5, 1.9%). 195 eyes of 168 patients fulfilled inclusion criteria
Summary
Cataract and glaucoma are the top two causes of blindness in the world respectively and they frequently co-exist in the same eye [1]. Treatment for patients with concurrent cataract and glaucoma includes sequential surgery and combined phacotrabeculectomy [4]. It reduces risks of additional intra-ocular surgeries, because frequently after trabeculectomy, there is rapid progression of lens opacities into visually significant cataracts that require cataract surgery [5]. Sequential cataract surgery is associated with increased risk of trabeculectomy failure which may be minimised by combined phacotrabeulectomy [6]. The effect of postoperative complications on phacotrabeculectomy success rates is unclear To address these gaps, we aimed to document the intraoperative and postoperative complications of combined phacotrabeculectomy with MMC in a multi-ethnic Asian population, and evaluate the impact of postoperative complications on surgical outcome
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