Abstract
PurposeTo evaluate the influence of phacoemulsification after trabeculectomy on the postoperative intraocular pressure (IOP) in eyes with uveitic glaucoma (UG).SettingKumamoto University Hospital, Kumamoto, Japan.DesignA retrospective cohort study.MethodsThe medical records of patients with UG who had trabeculectomy with mitomycin-C (MMC) were reviewed. Complete and qualified surgical failures were defined by an IOP of ≥21 mmHg (condition A), ≥18 mmHg (condition B), or ≥15 mmHg (condition C) without and with glaucoma eye drops, respectively. Kaplan-Meier survival analysis, generalized by the Wilcoxon test, and the Cox proportional hazards model analysis were conducted. Post-trabeculectomy phacoemulsification was treated as a time-dependent variable. In 24 (30%) of the included 80 eyes, phacoemulsification was included, and they were divided into two groups: groups I (8 eyes with phacoemulsification within 1 year after trabeculectomy) and group II (16 eyes after 1 year following trabeculectomy).ResultsMultivariable Cox proportional hazards model analysis showed post-trabeculectomy phacoemulsification was a significant factor in both complete success and qualified success based upon condition C (P = 0.0432 and P = 0.0488, respectively), but not for the other conditions. Kaplan–Meier survival analyses indicated significant differences in success probabilities between groups I and group II for complete success and qualified success based upon condition C (P = 0.020 and P = 0.013, respectively). There was also a significant difference for qualified success based upon condition B (P = 0.034), while there was no significant difference for the other conditions.ConclusionPost-trabeculectomy phacoemulsification, especially within 1 year, can cause poor prognosis of IOP control of UG eyes after trabeculectomy with MMC.
Highlights
Intraocular pressure (IOP) reduction has been regarded as the main target for the management of glaucoma
We reported that a history of phacoemulsification is associated with poor prognosis for trabeculectomy with MMC for treatment of open-angle glaucoma [5], [6]
We reported elevated levels of proinflammatory cytokines, such as monocyte chemoattractant protein and interleukin-8, in the aqueous humor after phacoemulsification, and their effects on surgical results of trabeculectomy in open-angle glaucoma [8], [9]
Summary
Intraocular pressure (IOP) reduction has been regarded as the main target for the management of glaucoma. We reported that phacoemulsification (especially within 1 year after trabeculectomy) is significantly related to the long-term failure of trabeculectomy and to resultant elevated IOP levels in eyes with open-angle glaucoma [7]. We show that the history of cataract surgery is associated with surgical failure, even in eyes with UG, and that UG eyes experience more frequent cataract surgeries after trabeculectomy than primary open-angle glaucoma (POAG) eyes. In these UG cases, phacoemulsification is required in addition to successful trabeculectomy, and postoperative inflammation could potentially affect control of the IOP.
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
