Abstract
ABSTRACTPurpose: To evaluate and compare the safety and efficacy of combined two-site phacoemulsification and trabeculectomy surgery with mitomycin C (MMC) in glaucoma-cataract patients with retrobulbar or topical anesthesia.Patients and methods: A retrospective, nonrandomized review of consecutive phacotrabeculectomy patients with a minimum follow-up time of 6 months, no previous glaucoma surgeries, and a preoperative visual acuity (VA) greater than light perception. The main outcome measures were preoperative and postoperative VA, intraocular pressure (IOP), use of glaucoma medications, and complications. A complete surgical success required an IOP from 6 to 18 mm Hg, no visually devastating complications, no return to surgery, and no use of glaucoma medications. Qualified success allowed the use of up to two glaucoma medications. Anesthesia groups were compared by student t-tests and log rank comparison of Kaplan-Meier survival rates.Results: Eighty-seven eyes (83 patients) met inclusion criteria, with a mean follow-up of 19 ± 12 months (6-57 months). The average eye gained 3.1 ± 4.9 lines of VA, lost 4.0 ± 7.1 mm Hg of IOP, and decreased 1.0 ± 1.3 glaucoma medications. Retrobulbar and topical anesthesia groups had statistically equivalent mean changes in VA (p = 0.910), IOP (p = 0.268), and use of glaucoma medications (p = 0.964). Postoperative complication rates were also statistically similar (p = 0.580). Complete success was greater in the retrobulbar group (p = 0.006), however, qualified success was equivalent in both groups (p = 0.769).Conclusion: Two-site phacotrabeculectomy with MMC in West Indian patients is as safe and effective for glaucoma-cataract patients with topical anesthesia as it is under retrobulbar anesthesia, and without short-term losses in VA and the chance of serious complications from injection.How to cite this article: Rodriguez R, Alburquerque R, Sauer T, Batlle JF. The Safety and Efficacy of Two-site Phacotrabeculectomy with Mitomycin C under Retrobulbar and Topical Anesthesia. J Curr Glaucoma Pract 2016;10(1):7-12.
Highlights
Glaucoma patients with visually significant cataracts are a frequent occurrence in the aging adult population
Complete success was greater in the retrobulbar group (p = 0.006), qualified success was equivalent in both groups (p = 0.769)
Two-site phacotrabeculectomy with mitomycin C (MMC) in West Indian patients is as safe and effective for glaucoma-cataract patients with topical anesthesia as it is under retrobulbar anesthesia, and without short-term losses in visual acuity (VA) and the chance of serious complications from injection
Summary
Glaucoma patients with visually significant cataracts are a frequent occurrence in the aging adult population. Cataract surgery alone can reduce IOP and glaucoma medication for over 2 years, Friedman et al found combined surgery generally achieves an additional 3 to 4 mm Hg lowering.[5,6] Trabeculectomy has been argued to have greater IOP control than phacotrabeculectomy; recent studies have found them effective.[7,8] Other points of contention in combined surgery have been the use of antimetabolite mitomycin C (MMC) and the separation of surgical sites. A 2005 review recommended the separation of surgical sites and the use MMC for IOP reduction in advanced or progressive glaucoma patients with incipient cataracts.[7] several authors have recently achieved comparable success rates with single
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