An Alternative Method of Phacoemulsification Surgery in Eyes with Functional Trabeculectomies
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Abstract
Aims: To report success proportions in functional trabeculectomised eyes undergoing phaco-emulsifcation with a novel curvilinear capsulorhexis method.
Methods: An observational series. Seventy two eyes of 72 patients were identified who underwent cataract surgery in eyes with functional prior trabeculectomy surgery using a Leweke cannula (cases). A previously reported group of 53 eyes in 53 patient who had routine cataract surgery (not using this technique) post-trabeculectomy surgery was used to compare outcomes (controls).
Main outcome measure: The primary outcome measure was intraocular pressure (IOP) success (IOP ≤21, ≤18, ≤15 mmHg) at 5 years post cataract surgery. Complete success was no new medication or surgical intervention for IOP and partial success was additional medical therapy required to achieve the IOP target.
Results: At final follow-up, the overall failure proportion of the combined groups for an IOP ≤21mmHg was 20% (24/125) at final review. Thirty percent who were a partial success prior to cataract surgery, failed in both controls and cases at final follow-up. Of those who were a complete success prior to phaco-emulsification; 33% were partial successes and 30% failed in the control group; 50% were partial successes and 10% failed in the case group, at final follow-up.
Logistic regression for an outcome of failure showed the Leweke cannula to be protective OR 0.28 (95% CI 0.09 to 0.85, p=0.03). African/Caribbean ethnicity was a risk factor for failure.
Conclusions: Our results suggest that cataract surgery may affect trabeculectomy outcomes, but not as profoundly as is currently perceived. Using the Leweke technique seems to result in earlier medication recommencement, but a strong reduction in the need for further surgical intervention in fully functional trabeculectomies.
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References
2 Mathew RG, Murdoch IE. The silent enemy: a review of cataract in relation to glaucoma and trabeculectomy surgery. Br J Ophthalmol 2011; 95:1350-4.
3 Watson PG & Grierson I (1981): The place of trabeculectomy in the treatment of glaucoma. Ophthalmology 88: 175–196.
4 Keenan TDL, Salmon JF, Yeates D, Goldacre MJ. Trends in rates of trabeculectomy in England. Eye 2009; 23: 1141–1149. doi:10.1038/eye.2008.195.
5 Kirwan JF, Lockwood AJ, Shah P, Macleod A, Broadway DC, et al. Trabeculectomy in the 21st century: a multicenter analysis. Ophthalmology (2013) 120: 2532–2539. doi: 10.1016/j.ophtha.2013.07.049
6 Fan Gaskin JC, Sandhu SS, Walland MJ Victorian trabeculectomy audit Clin Exp Ophthalmol. 2017 Sep;45(7):695-700. doi: 10.1111/ceo.12948
7 Wong MH et al. The Singapore 5-Fluorouracil trial. Ophthalmology 2013;120:1127-1134.
8 Chen PP, Weaver YK, Budenz DL, et al. Trabeculectomy function after cataract extraction. Ophthalmology 1998; 105:1928e35
9 Swamynathan K, Capistrano AP, Cantor LB, et al. Effect of temporal corneal phacoemulsification on intraocular pressure in eyes with prior trabeculectomy with an antimetabolite. Ophthalmology 2004;111:674e8
10 Crichton AC, Kirker AW. Intraocular pressure and medication control after clear corneal phacoemulsification and AcrySof posterior chamber intraocular lens implantation in patients with filtering blebs. J Glaucoma 2001;10:38e46
11 Rebolleda G, Munoz-Negrete FJ. Phacoemulsification in eyes with functioning filtering blebs: a prospective study. Ophthalmology 2002;109:2248e55
12 Park HJ, Kwon YH, Weitzman M, et al. Temporal corneal phacoemulsification in patients with filtered glaucoma. Arch Ophthalmol 1997;115:1375e80
13 Casson RJ, Riddell CE, Rahman R, et al. Long-term effect of cataract surgery on intraocular pressure after trabeculectomy. Extracapsular extraction versus phacoemulsification. J Cataract Refract Surg 2002;28:2159e64.
14 Wong TT, Khaw PT, Aung T, et al. The Singapore 5-fluorouracil trabeculectomy study: effect on intraocular pressure control and disease progression at 3 years. Ophthalmology 2009;116:175e84
15 Ehnrooth P, Lehto I, Puska P, et al. Phacoemulsification in trabeculised eyes. Acta Ophthalmol Scand 2005;83:561e6
16 Siriwardena D, Kotecha A, Minassian D et al. Anterior chamber flare after trabeculectomy and after phacoemeulsification. Br J Ophthalmol 2000;84:1056-7
17 Manoj B, Chako D, Khan MY. Effect of extracapsular cataract extraction and phacoemulsification performed after trabeculectomy on intraocular pressure. J Cataract Refract Surg 2000 Jan; 26(1):75-78.
18 Shingleton BJ, O’Donoghue MW, Hall PE. Results of phacoemulsification in eyes with preexisting glaucoma filters. J Cataract Refract Surg 2003 Jun; 29(6):1093-1096.
19 Derbolav A, Vass C, Menapace R, Schmetterer K, Wedrich A. Long-term effect of phacoemulsification on intraocular pressure after trabeculectomy. J Cataract Refract Surg 2002 Mar; 28(3):425-430.
20 Sałaga-Pylak M, Kowal M, Żarnowski T. Deterioration of filtering bleb morphology and function after phacoemulsification. BMC Ophthalmol 2013 Apr 23;13:17.
21 Klink J, Schmitz B, Lieb WE, Klink T, Grein H-J, Sold-Darseff J, Heinold A, Grehn F. Filtering bleb function after clear cornea phacoemulsification: a prospective study. Br J Ophthalmol 2005;89:597-601 doi:10.1136/bjo.2004.041988
22 Husain R, Liang S, Foster PJ, et al. Cataract Surgery After Trabeculectomy: The Effect on Trabeculectomy Function. Arch Ophthalmol. 2012;130(2):165-170. doi:10.1001/archophthalmol.2011.329
23 Nguyen DQ, Niyadurupola N, Tapp RJ, O’Connell RA, Coote MA, Crowston JG. Effect of phacoemulsification on trabeculectomy function. Clin Experiment Ophthalmol. 2014 Jul;42(5):433-9. doi: 10.1111/ceo.12254. Epub 2013 Dec 17
24 Mathew RG, Parvizi S, Murdoch IE. Success of trabeculectomy surgery in relation to cataract surgery: 5-year outcomes. Br J Ophthalmol 2019;103:1395–1400
25 Riva I, Katsanos A, Oddone F, Quaranta L The Effect of Phacoemulsification on Intraocular Pressure in Eyes with Hyperfiltration Following Trabeculectomy: A Prospective Study Adv Ther. 2018 Jan;35(1):116-123.
doi: 10.1007/s12325-017-0646-0
26 Shaarawy TM, Sherwood MB, Grehn F. Guidelines on Design and Reporting of Glaucoma Surgical Trials. 2009 ISBN 10: 90-6299-219-6; Kugler Publications
27 Siriwardena D, Kotecha A, Minassian D, Dart JK, Khaw PT Anterior chamber flare after trabeculectomy and after phacoemulsification. Br J Ophthalmol. 2000 Sep;84(9):1056-7.
28 Mathew RG, Parvizi S, Murdoch IE. Success of trabeculectomy surgery in relation to cataract surgery: 5-year outcomes. Mathew RG, et al. Br J Ophthalmol 2019;103:1395–1400
29 Wang X, Zhang H, Li S et al The effect of phacoemulsification on intraocular pressure and ultrasound bio-microscopic image of filtering blebs in eyes with cataract and functioning filtering blebs Eye 2009:23:112-116