Effect of Phacoemulsification on Intraocular Pressure Control in Primary Open Angle Glaucoma Previously Treated by Trabeculectomy: A Case-Control Study

Samir Aziz, Nicky Spiers, Jeffrey Jay

Moorfields Eye Hospital NHS Foundation Trust, London, England.
Tennent Institute of Ophthalmology, Gartneval General Hospital, Glasgow, Scotland.
University of Leicester, Leicester, England..

DOI: 10.4236/ojoph.2012.22004                

Abstract

Purpose: To analyse the effect of phacoemulsification on the control of intraocular pressure in primary open angle glaucoma in patients having phacoemulsification after previous trabeculectomy and compare them with a control group who had trabeculectomy alone. Patients and Methods: Twenty one patients (one eye from each) who had phacoemulsification subsequent to trabeculectomy were identified, and compared with 41 controls. Intraocular pressure, bleb appearance, glaucoma medications, iris manipulation and complications were recorded. Each patient was followed for full 12 months. Failure of control was defined as follows: 1) intraocular pressure >21 mm Hg on medication, or 2) a greater number of glaucoma medications than before phacoemulsification. Results: The post operative change in intraocular pressure in the case group at 12 months was much less than that in the control (p = 0.001). The mean intraocular pressure had changed from 15.3 mm Hg to 14.7 mm Hg. The control group showed an average intraocular pressure reduction of 6 mm Hg at the last visit (p > 0.001). In phacoemulsification group, 19% required 1 or 2 glaucoma medications at one year follow-up vs 19.5% in the control group. In phacoemulsification group, 9.5% showed flattening of a previously formed bleb at the last visit (P < 0.001), compared with 9.7% of controls. Conclusions: The stability of glaucoma control in the first year after phacoemulsification in previously filtered eyes with primary open angle glaucoma is comparable to that of the natural course after trabeculectomy. The study is limited by the small number of cases available.

Keywords

Phacoemulsification; Trabeculectomy; Cataract; Glaucoma

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	D. Halikiopoulos, M. R. Moster, A. Azuara-Blanco, R. P. Wilson, C. M. Schmidt , G. L. Spaeth, L. J. Katz and J. J. Augsburger, “The Outcome of The Functioning Filter after Subsequent Cataract Extraction,” Ophthalmic Surgery and Lasers, Vol. 32, No. 2 , 2001, pp. 108-117.
[2]	D. S. Friedman, H. D. Jampel, L. H. Lubomski, J. H. Kempen, H. Quigley, N. Congdon, H. Levkovitch-Verbin, K. A. Robinson and E. B. Bass, “Surgical Strategies for Coexisting Glaucoma and Cataract-An Evidence-Based Update,” Ophthalmology, Vol. 109, No. 10, 2002, pp. 1902-1913. doi:10.1016/S0161-6420(02)01267-8
[3]	S. A. Obstbaum, “Glaucoma and Intraocular Lens Implantation,” Journal of Cataract and Refractive Surgery, Vol. 12, No. 3, 1986, pp. 257-261.
[4]	P. Ehrnrooth, I. Lehto, P. Puska and L. Laatikainen, “Phacoemulsification in Trabeculectomized Eyes,” Acta Ophthalmologica Scandanavia, Vol. 83, No. 5, 2005, pp. 561-566. doi:10.1111/j.1600-0420.2005.00499.x
[5]	F. D’Ermo, L. Bonomi and D. Doro, “A Critical Analysis of the Long-Term Results of trabEculectomy,” American Journal of Ophthalmology, Vol. 88, No. 5, 1979, pp. 829- 835.
[6]	K. B. Mills, “Trabeculectomy: A Retrospective Long-Term Follow-Up of 444 Cases,” British Journal of Ophthalmology, Vol. 65, No. 11, 1981, pp. 790-795. doi:10.1136/bjo.65.11.790
[7]	P. G. Watson, C. Jakeman, M. Oztur, M. F. Barnett, F. Barnett and K. T. Khaw, “The Complications of Trabeculectomy (a 20 Year Follow-Up),” Eye, Vol. 4, No. 3, 1990, pp. 425-438. doi:10.1038/eye.1990.54
[8]	A. C. B. Molteno, N. J. Bosma and J. M. Kittleson, “Otago Gluacoma Surgery Outcome Study: Long-Term Results of Trabeculectomy—1976 to 1995,” Ophthalmology, Vol. 106, No. 9, 1999, pp. 1742-1750. doi:10.1016/S0161-6420(99)90351-2
[9]	M. Sheilds, “Another Reevaluation of Combined Cataract and Glaucoma Surgery,” American Journal of Ophthalmology, Vol. 115, No. 6, 1993, pp. 806-811.
[10]	P. P. Chen, Y. K. Weaver, D. L. Budenz, W. J. Feuer and R. K. Parrish, II, “Trabeculectomy Function after Cataract Extraction,” Ophthalmology, Vol. 105, No. 10, 1998, pp. 1928-1935. doi:10.1016/S0161-6420(98)91044-2
[11]	B. Manoj, D. Chako and M. Y. Khan, “Effect of Extracapsular Cataract Extraction and Phacoemulsification Performed after Tra-beculectomy on Intraocular Pressure,” Journal of Cataract & Refractive Surgery, Vol. 26, No. 1, 2000, pp. 75-78. doi:10.1016/S0886-3350(99)00321-1
[12]	M. A. Dickens and L. F. Cashwell, “Long-Term Effect of Cataract Extraction on the Function of an Established Filtering Bleb,” Ophthalmic Surgery & Lasers, Vol. 27, No. 1, 1996, pp. 9-14.
[13]	S. K. Seah, A. Jap, J. A. Prata, G. Baerveldt, P. P. Lee, D. K. Heuer and D. S. Minckler, “Cataract Surgery after Trabeculectomy, “Ophthalmic Surgery & Lasers, Vol. 27, No. 7, 1996, pp. 587-594.
[14]	H. J. Park, Y. H. Kwon, M. Weitzman and J. Caprioli, “Temporal Corneal Phacoemulsification in Patients with Filtered Glaucoma,” Archives of Ophthal-mology, Vol. 115, No. 11, 1997, pp. 1375-1380. doi:10.1001/archopht.1997.01100160545003
[15]	A. C. S. Crichton and A. W. Kirker, “Intraocular Pressure and Medication Control after Clear Corneal Phacoemulsifica-tion and Acrysof Posterior Chamber Intraocular Lens Im-plantation in Patients with Filtering Blebs,” Journal of Glaucoma, Vol. 10, No. 1, 2001, pp. 38-46. doi:10.1097/00061198-200102000-00008
[16]	R. J. Casson, C. E. Riddell, R. Rahman, D. Byles and J. F. Salmon, “Long-Term Effect of Cataract Surgery on Intraocular Pressure after Trabeculectomy-Extra Extraction Versus Phacoemulsification,” Journal of Cataract & Refractive Surgery, Vol. 28, No. 1, 2002, pp. 2159-2164. doi:10.1016/S0886-3350(02)01501-8
[17]	G. Rebolleda and F. J. Mu?oz-Negrete, “Phacoemulsification in Eyes with Functioning Filtering Blebs: A Prospective Study,” Ophthalmology, Vol. 109, No. 12, 2002, pp. 2248-2255. doi:10.1016/S0161-6420(02)01246-0
[18]	J. Klink, B. Schmitz, W. E. Lieb, T. Klink, H. J. Grein, J. Sold-Darseff, A. Heinold and F. Grehn, “Filtering Bleb Function after Clear Cornea Phacoemulsification: A Prospective Study,” British Journal of Ophthalmology, Vol. 89, No. 5, 2005, pp. 597-601. doi:10.1136/bjo.2004.041988
[19]	K. S. Kooner, D. D. Dulaney and T. J. Zimmerman, “Intraocular Pressure Following Ecce and Iol Implantation in Patients with Glaucoma,” Ophthalmic Surgery, Vol. 19, No. 8, 1988, pp. 570-575.
[20]	T. K. Sharma, S. Arora and P. G. Corridan, “Phacoemul-sification in Patients with Previous Trabeculectomy: Role of 5-Flourouracil,” Eye, Vol. 21, No. 6, 2007, pp. 780-783. doi:10.1038/sj.eye.6702327
[21]	G. S. Ang, M. Shunmugam and A. Azuara-Blanco, “Effect of Cataract Extraction on the Glaucoma Progression Index (GPI),” Journal of Glaucoma, Vol. 19, No. 4, 2010, pp. 275-278.
[22]	R. T. Oyakawa and A. E. Maumenee, “Clear Cornea Cataract Extraction in Eyes with Functioning Bleb,” American Journal of Ophthalmology, Vol. 93, No. 3, 1982, pp. 294-298.
[23]	W. Doyle and M. F. Smith, “Effect of Phacoemulsification Surgery on Hypotony Following Trabeculectomy Surgery,” Archives of Ophthalmology, Vol. 118, No. 6, 2000, pp. 763-765.
[24]	A. Derbolav, C. Vass, R. Menapace, K. Schmetterer and A. Wedrich, “Long-Term Effect of Phacoemulsification on Intraocular Pressure after Trabeculectomy,” Journal of Cataract & Refractive Surgery, Vol. 28, No. 3, 2002, pp. 425-430. doi:10.1016/S0886-3350(01)01189-0
[25]	X. Wang, H. Zhang, S. Li and N. Wang, “The Effects of Phacoemulsi-fication on Intraocular Pressure and Ultrasound Biomicroscopic Image of Filtering Bleb in Eyes with Cataract and Functioning Filtering Blebs,” Eye, Vol. 23, No. 1, 2009, pp. 112-116. doi:10.1038/sj.eye.6702981
[26]	R. Casson, R. Rahman and J. F. Salmon, “Phacoemulsification with Intraocular Lens Implantation after Trabecu-lectomy,” Journal of Glaucoma, Vol. 11, No. 5, 2002, pp. 429-433. doi:10.1097/00061198-200210000-00011
[27]	L. B. Cantor, A. Mantravadi, D. WuDunn, K. Swamynathan and A. Cortes, “Morphologic Classification of Filtering Blebs after Glaucoma Filtration Surgery: The Indiana Bleb Appearance Grading Scale,” Journal of Glaucoma, Vol. 12, No. 3, 2003, pp. 266-271. doi:10.1097/00061198-200306000-00015
[28]	Y. H Kwon, C. S. Kim, M. B. Zimmerman, W. L. Alward and S. S. Hayreh, “Rate of Visual Loss and Long-Term Visual Outcome in Primary Open-Angle Glaucoma,” American Journal of Ophthalmology, Vol. 132, No. 1, 2001, pp. 47-56. doi:10.1016/S0002-9394(01)00912-6
[29]	J. F. Murchison and M. B. Sheilds, “An Evaluation of Three Surgical Approaches for Coexisting Cataract and Glaucoma,” Ophthalmic Surgery, Vol. 20, No. 6, 1989, pp. 393-398.
[30]	J. F. Bigger and B. Becker, “Cataracts and Primary Open Angle Glaucoma: The Effect of Uncomplicated Cataract Extraction on Glaucoma Control,” Transactions of the American Academy of Ophthalmology and Otolaryngology, Vol. 75, No. 2, 1971, pp. 260-272.