Abstract
PurposeTo determine the medium-term outcomes for patients with advanced glaucoma undergoing viscocanalostomy.MethodsAll patients with advanced glaucoma (mean deviation (MD) − 12.00 dB or above) and patients with poor visual acuity secondary to advanced glaucoma which precluded formal visual field assessment undergoing viscocanalostomy (VC) and phaco-viscocanalostomy between 2010 and 2014 under the care of a single surgical team were included. Intraocular pressure (IOP), visual acuity (VA) and visual field outcomes were assessed from data prospectively collected into a surgical outcome database. Success was defined at two IOP cut-off points: IOP ≤ 21 and ≤ 16 mmHg with (qualified) or without (complete) medications.ResultsOne hundred thirty-five patients were included. Mean IOP changed from 23.6 ± 6.4 mmHg pre-operatively to 15.3, 15.8 and 14.8 mmHg at 1, 2 and 3 years, a change of 35, 33.5 and 39% respectively. Qualified success for an IOP ≤ 21 mmHg was achieved in 95.66, 90.6 and 80% and complete success in 52.5, 48.6 and 30.6% at year 1, 2 and 3. Qualified success for an IOP ≤ 16 mmHg was achieved in 66.6, 66.05 and 60% and complete success in 44.8, 37.6 and 30.6% at year 1, 2 and 3. The cumulative probability for achieving an IOP ≤ 21 mmHg with or without drops was 86.1, 81.4 and 81.4% at 12, 24 and 36 months. Eleven patients (8.1%) failed to achieve adequate IOP control and needed further surgical intervention. Eleven (8.1%) patients needed an intervention (Yag goniopuncture) following VC. Four patients (2.9%) had some post-operative complications, which resolved within 2 weeks following surgery. Nine patients (6.7%) lost more than 2 Snellen lines. There was no significant change in the MD across time points.ConclusionViscocanalostomy and viscocanalostomy combined with phacoemulsification is a safe and effective method of controlling IOP in the medium term in patients with advanced glaucoma.
Highlights
Patients most at risk of blindness during their lifetime, due to glaucoma, are those who present with advanced disease
National Institute for Health and Clinical Excellence (NICE) guidelines recommend primary surgery for patients presenting with advanced disease [6]
Twenty-five patients had had some previous intervention for glaucoma including trabeculectomy, cyclodiode laser, argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT) (Table 1)
Summary
Patients most at risk of blindness during their lifetime, due to glaucoma, are those who present with advanced disease. Almost 60% of patients progressing to statutory blindness have one eye with an MD worse than − 14 dB at baseline [1]. Ten to thirty-nine percent of glaucoma patients present with advanced disease in at least one eye in the UK [2,3,4]. University of Cumbria, Lancaster, England specialists in the UK is to start with primary medical therapy, citing surgical risk as the primary reason behind it (23 and 22% respectively) [5]. National Institute for Health and Clinical Excellence (NICE) guidelines recommend primary surgery for patients presenting with advanced disease [6]. There is limited evidence supporting this recommendation and the type of surgery to be offered
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