Single Site Phacotrabeculectomy Research Articles

Safety and Efficacy of Single-site Phacotrabeculectomy With Mitomicin C Using Nylon and Polyglactin Suture for Scleral Tunnel Closure.

To evaluate the efficacy of polyglactin use along with nylon suture in scleral tunnel closure after single-site phacotrabeculectomy. This retrospective case series included 139 eyes of 139 patients who had scleral tunnel closure with 1 polyglactin and 1 nylon suture after single-site phacotrabeculectomy with a low dose of mitomycin C between 2002 and 2005. The intraocular pressure (IOP), the visual acuity, the number of glaucoma medications, postoperative complications, and interventions were the outcomes measured. The majority of them had primary open-angle glaucoma (93 eyes, 67%), 93 eyes (67%) had severe glaucomatous optic neuropathy, and 77 eyes (55.3%) had severe visual-field loss. The IOP decreased from a mean preoperative value of 18.1±5.3 mm Hg on a mean number of 1.8±0.8 glaucoma medications to mean IOPs of 13.3±4.6, 14.0±4.3, and 11.8±3.9 mm Hg on a mean number of 0.2±0.6, 0.3±0.7, 0.5±1.0 glaucoma medications (P<0.001) at 1-, 3-, and 5-year follow-up visits, respectively. An IOP of <21 mm Hg with or without medication was achieved in 96±2% at 1 year, in 88±4% at 3 years, and in 73±8% at 5 years. Shallow anterior chamber was the most common early postoperative complication (3 eyes, 2.1%). Nylon suturelysis with laser was performed in 16 eyes (11.5%). The technique used here seems to be effective in controlling the IOP and has very minimal associated complications.

A Comparative Evaluation of Phacotrabeculectomy with Manual Phacofracture Trabeculectomy

Purpose: To compare the results of manual phacofracture trabeculectomy (manual small incision cataract surgery trabeculectomy) versus phacotrabeculectomy with respect to visual gain and intraocular pressure (IOP) control. Materials and Methods: Thirty consecutive patients who underwent combined surgery performed by the same surgeon were prospectively evaluated for a minimum period of 12 months. Fifteen patients underwent single site phacotrabeculectomy, and the remaining 15 patients underwent single site phacofracture trabeculectomy at Guru Nanak Eye Hospital, New Delhi. Results: Both surgeries resulted in a highly significant decrease in IOP, the final percentage reduction being 46% in phacotrabeculectomy group and 44% in phacofracture trabeculectomy group. The complete success rate (IOP < 21 mmHg) without additional antiglaucoma medications was 100% for both the groups till l2 months of follow-up. Improvement in visual acuity was similar in both the groups with 53% patients in phacotrabeculectomy and 60% in phacofracture trabeculectomy group attaining a final visual acuity of 20/40 or better. The mean surgically induced astigmatism was 1.33 D and 1.3 D in phacotrabeculectomy and phacofracture trabeculectomy group respectively, at the end of 12 months follow-up. Manual phacofracture trabeculectomy resulted in more early postoperative inflammation within the first 7 days. Conclusions: There was no statistically significant difference in the final visual acuity, IOP control and surgically induced astigmatism between phacofracture trabeculectomy and phacotrabeculectomy groups.

English

AIM: To evaluate and compare efficacy and outcome after single site phacotrabeculectomy and two sites phacotrabeculectomy in cases of coexisting open angle, angle closure and lens induced glaucoma and cataract. MATERIALS AND METHODS: This study was randomized, prospective, interventional and comparative clinical trial. The present study of combined cataract extraction with trabeculectomy was done in tertiary centre. In the present study of combined cataract extraction with trabeculectomy 28 eyes were operated upon and follow-up was done between 2 months to 14.5 months. RESULT: There is early restoration of good vision in 75% of cases. A good tension control is achieved. Tension can be controlled in 85.7% eyes with surgery, while overall tension control with post-operative medical therapy can be achieved in 92.85% eyes. The average reduction of intra-ocular pressure after this reduction of intra-ocular pressure after this procedure is more than 50% and it is highly significant statistically (P < 0.001). CONCLUSION: The combined operation of trabeculectomy and cataract extraction by phacoemulsification give results comparable to those obtained for separate procedures in terms of intraocular pressure control restoration of vision. The advantages of combined procedure outweigh the small increase in the risks

Safety and Efficacy of Using Off-Label Bevacizumab Versus Mitomycin C to Prevent Bleb Failure in a Single Site Phacotrabeculectomy by a Randomized Controlled Clinical Trial

Safety and Efficacy of Using Off-Label Bevacizumab Versus Mitomycin C to Prevent Bleb Failure in a Single Site Phacotrabeculectomy by a Randomized Controlled Clinical Trial

Reply to “Safety and Efficacy of Using Off-Label Bevacizumab Versus Mitomycin C to Prevent Bleb Failure in a Single Site Phacotrabeculectomy by a Randomized Controlled Clinical Trial”

Aravind Eye Hospital Thavalakuppam, Puducherry, India Disclosure: The author declares no conflict of interest.

Safety and Efficacy of Using Off-label Bevacizumab Versus Mitomycin C to Prevent Bleb Failure in a Single-site Phacotrabeculectomy by a Randomized Controlled Clinical Trial

To analyze the safety and efficacy of bevacizumab (1.25 mg/0.05 mL) versus 0.03% mitomycin C (MMC) for preventing bleb failure in patients undergoing single-site phacotrabeculectomy for primary open-angle glaucoma or chronic angle-closure glaucoma. Thirty-eight consecutive patients with visually significant cataract and coexistent primary open-angle glaucoma or chronic angle-closure glaucoma were randomized into 3 groups. One group received conventional 0.03% MMC (n=13); the second group received 3 subconjunctival injections of bevacizumab (1.25 mg in 0.05 mL) (n=13); and the third group received bevacizumab soaked in sponges (1.25 mg in 0.05 mL) (n=12) intraoperatively on the sclera. Patients were followed up for 6 months. The primary outcome measure was treatment success and bleb morphology in the study eye at 6-month follow-up. All 3 groups showed significant reduction in mean intraocular pressure at 1 week after treatment, which was maintained at 6 months. However, the subconjunctival bevacizumab group had 90% patients with complete success as opposed to 60% in each of the other 2 groups (P=0.04). In both bevacizumab groups, bleb vascularity increased progressively over the 6-month follow-up. One patient in the subconjunctival bevacizumab group showed a local conjunctival necrosis. In this pilot study with a small number of subjects, short-term outcomes suggest that subconjunctival bevacizumab is equally effective in reducing intraocular pressure with a better safety profile compared with MMC in the dosing schedule studied. However, bevacizumab soaked in a sponge appears to have no advantages over MMC. Subconjunctival bevacizumab may be a useful agent for improving success and for limiting scar tissue after phacotrabeculectomy.

Phacotrabeculectomy Without Mitomycin C in Primary Angle-closure and Open-angle Glaucoma

To compare the surgical outcomes of single site phacotrabeculectomy without mitomycin C (MMC) in primary angle-closure glaucoma (PACG) and primary open-angle glaucoma (POAG). We retrospectively reviewed the records of all patients with a diagnosis of PACG and POAG, who underwent single site phacotrabeculectomy without MMC between January 2001 and December 2005 and had a minimum follow-up of 12 months. The primary outcome measure was cumulative success probability, defined as complete [intraocular pressure (IOP) ≤21 mm Hg without antiglaucoma medications or additional surgery] and qualified (IOP <21 mm Hg with medications). Secondary outcome measures were reduction of IOP, the number of antiglaucoma medications at last follow-up, and complication rates. Seventy-one eyes of 63 PACG patients (mean age 61.2 y) and 72 eyes of 57 POAG patients (mean age 64.0 y) were analyzed. Mean duration of follow-up was 38.7 and 41.7 months in the PACG and POAG groups, respectively. Complete success in PACG (72.1%) was more than the POAG group (56.1%), but the difference was not statistically significant (P=0.06). Qualified success in the PACG and POAG group was 87.4% and 92.8%, respectively (P=0.43). IOP reduction was greater (P=0.03) in the PACG group and PACG group required fewer antiglaucoma medications postoperatively (P=0.03) for IOP control. Survival probability of single site phacotrabeculectomy without MMC was not significantly different between the PACG and POAG groups. IOP reduction was greater and the need for antiglaucoma medications after surgery was lesser in the PACG group.

Review of consecutive phacotrabeculectomies supplemented with early needle revision and antimetabolites

Background: To describe the results of a novel postoperative management approach for patients undergoing combined cataract and glaucoma surgery supplemented with early needle revision and antimetabolites. Methods: Consecutive retrospective chart review identified 66 patients who had undergone combined cataract and glaucoma surgery with early needling and antimetabolite injections between January 2002 and May 2003; 8 patients were excluded from analysis because of missing data or inadequate follow-up time. Single-site phacotrabeculectomy was performed followed by subconjunctival antimetabolite injections of 5-fluorouracil (5-FU). Needling was performed as an office procedure if early evidence of subconjunctival scarring was observed 2–6 weeks after surgery. Additional subconjunctival 5-FU injections were administered after needling, and repeat needling was performed with 5-FU or mitomycin-C if subconjunctival scarring recurred. A complete success was defined as a reduction in intraocular pressure (IOP) to <18 mm Hg without the use of antiglaucoma medications or further surgical procedures to control IOP. The outcome was considered a qualified success when antiglaucoma medications were required to achieve the same result. Results: The mean preoperative IOP was 21.9 (SD 6.3) mm Hg, and the mean postoperative IOP at 6 months was 13.0 (SD 6.7) mm Hg. The mean number of medications was reduced from 2.9 (SD 1.3) preoperatively to 0.5 (SD 0.9) postoperatively at 6 months. Needling was performed because of early evidence of subconjunctival scarring in 34 patients. The 6-month outcomes of 37 patients (64%) were a complete success and of 47 patients (81%) were a complete or qualified success. A longer follow-up of 10–23 months was attained in 25 of the 58 patients. At latest visit, the mean postoperative IOP of this group was 13.0 (SD 5.5) mm Hg, the mean number of postoperative medications was 0.7 (SD 1), and 21 of the 25 (84%) had achieved a complete or qualified success. The most common complication for all 58 patients was an early, self-limited postoperative wound leak that was unrelated to the needling intervention and was observed in 26 patients (45%). Interpretation: Phacotrabeculectomy supplemented with early needle revision and antimetabolites may improve outcomes of combined cataract and glaucoma surgery.

Trabeculectomy and phacotrabeculectomy, with mitomycin-C, show similar two-year target IOP outcomes

Background: To determine the efficacy and safety of trabeculectomy with mitomycin-C (trabMMC) compared with that of single-site phacotrabeculectomy with mitomycin-C (phacotrabMMC) in glaucoma patients at increased risk for filtering surgery failure. Methods: Eighty-five consecutive eyes that underwent trabMMC and 105 consecutive eyes that underwent phacotrabMMC were retrospectively compared up to 2 years postoperatively with respect to intraocular pressure (IOP), number of glaucoma medications, and surgical complication rates. The primary outcome was the difference in the cumulative proportion of patients meeting the target IOP range at 2 years. Secondary outcomes included mean postoperative IOP, mean IOP drop from baseline, mean number of glaucoma medications, and surgical complication rates. Results: Baseline characteristics were similar in the 2 groups and most patients had advanced glaucoma with a similar upper limit of the target IOP range (15.5 ± 2.6 mm Hg for trabMMC vs. 15.3 ± 2.1 mm Hg for phacotrabMMC, p = 0.56). Loss to follow-up was significant in both groups (almost 50% over 2 years). A statistically similar proportion of patients achieved their target IOP range at 1 and 2 years in both groups: the cumulative success rate at 2 years was 29.04% and 22.91% ( p = 0.44) without add-on glaucoma therapy, 25.38% and 25.22% (p = 0.60) with the use of up to 2 glaucoma medications, and 30.01% and 25.17% ( p = 0.81) with the use of any number of glaucoma medications, in the trabMMC and phacotrabMMC groups, respectively. Mean postoperative IOP was also similar between the 2 groups at almost all follow-up times up to 2 years (13.56 ± 4.92 mm Hg in trabMMC vs. 13.98 ± 4.74 mm Hg in phacotrabMMC at 2 years, p = 0.67). The mean IOP drop from baseline was significantly greater in the trabMMC group throughout the study period (−10.87 ± 8.33 mm Hg in trabMMC vs. −6.15 ± 7.01 mm Hg in phacotrabMMC at 2 years, p = 0.003); however, baseline IOP was also higher in the trabMMC group (26.1 mm Hg vs. 20.3 mm Hg, p < 0.0001). Serious postoperative complication rates were similarly low between the 2 groups. Interpretation: TrabMMC and phacotrabMMC may be equally safe and effective in bringing IOP to within an acceptable target range over 2 years in advanced glaucoma patients at increased risk for filtering surgery failure, although trabMMC appears to be associated with greater IOP lowering from baseline.

Phacotrabeculectomy versus conventional combined technique in coexisting glaucoma and cataract

Background: To evaluate and compare efficacy and outcome after single site phacotrabeculectomy and conventional combined surgery in cases of coexisting primary open angle glaucoma and cataract. Methods: This prospective study on fifty patients of concurrent primary open angle glaucoma and cataract, who had undergone combined surgery as single site phacotrabeculectomy or conventional single site trabeculectomy with extracapsular lens extraction with IOL implantation in 25 cases each. Evaluation was based on operative and postoperative complications, control of IOP and visual outcome. The follow up period ranged between twelve months to eighteen months. Results: The mean medically controlled preoperative intraocular pressure was 22 mm of Hg (Range 18 to 35 mm of Hg) by applanation method of tonometry. The range of postoperative intra-ocular pressure after one year was 11 to 22 mm of Hg in first and 14 to 26 mm Hg in second group. Failure to maintain optimum postoperative IOP without Beta-blocker was more frequent after conventional combined procedure. There was no significant difference in incidence and pattern of postoperative complications. Conclusion: Phacotrabeculectomy provides effective and sustained visual recovery and adequate control of intraocular pressure as compare to conventional combined procedure.

Surgically-induced astigmatism following single-site phacotrabeculectomy, phacotrabeculotomy and advanced non-penetrating phacotrabeculectomy

We study surgically-induced astigmatism following three kinds of glaucoma surgeries combined with cataract surgery with 6 months of follow-up. The mean surgically-induced astigmatism at 6 months postoperatively was 1.92 ± 1.87 diopters in phacotrabeculectomy (n = 45), 0.72 ± 0.40 diopters in advanced non-penetrating phacotrabeculectomy (n = 40) and 0.76 ± 0.47 diopters in phacotrabeculotomy (n = 49), which appeared to be stabilized by 3 months. Each group revealed a tendency of “with the wound” induced astigmatism. Phacotrabeculectomy could induce greater surgically-induced astigmatism than advanced non-penetrating phacotrabeculectomy and phacotrabeculotomy.