Abstract
ABSTRACTPurpose: To compare the efficacy of different surgical strategies for intraocular pressure (IOP) control in Hispanic glaucoma patients with and without visually significant cataracts.Design: Comparative retrospective consecutive case series.Methods: The charts of 153 consecutive patients with primary open angle glaucoma who underwent either trabeculectomy alone (n = 51), phacotrabeculectomy (n = 51), or phacoemulsification alone (n = 51) were reviewed to compare IOP control, the number of glaucoma medications required postoperatively, and the inci dence of surgical complications.Results: Preoperative IOP was 17.5 ± 5.2 mm Hg in the trabe-culectomy group, 15.4 ± 4.5 mm Hg in the phacotrabeculectomy group and 13.9 ± 2.9 mm Hg in the phacoemulsification group (p < 0.001 for all comparisons). Mean IOP reduction from baseline was 4.2 ± 6.9 (24.6%) for the trabeculectomy group, 2.9 ± 5.0 (20.8%) for the phacotrabeculectomy group, and 0.9 ± 3.4 (6.5%) for the phacoemulsification group (p = 0.009). The number of IOP-lowering medications required postoperatively decreased significantly in all three groups (p = 0.001). The rate of early and late postoperative complications was similar between the trabeculectomy and phacotrabeculectomy groups and less for the phacoemulsification group.Conclusion: Trabeculectomy and phacotrabeculectomy are both viable surgical options for managing open angle glau coma. Both resulted in similar rates of success, IOP reduction, decrease in use of IOP-lowering medications and post operative complication rates. Phacoemulsification alone had a lower success rate and greater need for postoperative IOP-lowering medications compared to trabeculectomy alone or phacotrabeculectomy. Phacoemulsification alone may be a reasonable option for patients with visually significant cataract and lower baseline IOP.How to cite this article: Jung JL, Isida-Llerandi CG, Lazcano-Gomez G, SooHoo JR, Kahook MY. Intraocular Pressure Control after Trabeculectomy, Phacotrabeculectomy and Phaco-emulsification in a Hispanic Population. J Curr Glaucoma Pract 2014;8(2):67-74.
Highlights
Glaucoma is a leading cause of blindness worldwide, and it is estimated that it will affect 79.6 million people by 2020.1 In recent years, several population-based prevalence studies have been published, reporting high rates of open angle glaucoma in the Hispanic/Latino population.[2,3] In 2011, primary open angle glaucoma (POAG) was most commonly seen in non-Hispanic white women aged 70 to 79 in the United States.[4]
Trabeculectomy and phacotrabeculectomy are both viable surgical options for managing open angle glaucoma. Both resulted in similar rates of success, intraocular pressure (IOP) reduction, decrease in use of IOP-lowering medications and postoperative complication rates
Phacoemulsification alone had a lower success rate and greater need for postoperative IOP-lowering medications compared to trabeculectomy alone or phacotrabeculectomy
Summary
Glaucoma is a leading cause of blindness worldwide, and it is estimated that it will affect 79.6 million people by 2020.1 In recent years, several population-based prevalence studies have been published, reporting high rates of open angle glaucoma in the Hispanic/Latino population.[2,3] In 2011, primary open angle glaucoma (POAG) was most commonly seen in non-Hispanic white women aged 70 to 79 in the United States.[4]. Cataracts often progress following a trabec ulectomy, which necessitates subsequent cataract removal.[8,9] When patients undergo two sequential surgeries, Journal of Current Glaucoma Practice, May-August 2014;8(2):[67-74] they may have a longer visual rehabilitation and a higher risk of bleb failure with the second surgery.[10,11] Some studies suggest that combined procedures may be less successful at reducing IOP than trabeculectomy alone[12] while others report similar efficacy.[13] Often, surgeons base their decision for a particular surgery on an individual basis, depending on many factors including the patient’s IOP control, visual field progression, appearance of the optic nerve, and prior interventions. We add to this growing body of knowledge by comparing the effectiveness of IOP control and medication independence for trabeculectomy alone, combined phacotrabeculectomy, and phacoemulsification alone with a focus on a Latino population of Mexican ancestry
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