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Marc Toeteberg-Harms, Swarup Swaminathan, Seung Youn Jea, Amir Marvasti, Kyuryong Choi, Julie Kim, Louis Pasquale, Douglas Rhee; Comparison of Phacoemulsification Combined with ab interno Trabeculectomy (AIT), or with Trabeculectomy (Trab), and Phaco Alone for the Management of Cataract and Open-Angle Glaucoma. Invest. Ophthalmol. Vis. Sci. 2013;54(15):2138.
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Eyes with POAG frequently develop cataracts. We evaluated the use of phaco, phaco+AIT, and phaco+trab in this population. We hypothesized that 1) IOP reduction of phaco-trab would be greater than phaco and phaco-AIT, 2) phaco-AIT has a lower complication rate than phaco-trab, and 3) phaco-AIT and phaco-trab would have lower rate of acute IOP elevations (IOP spikes).
Exclusion criterion of this retrospective case-controlled comparative series was previous incisional glaucoma surgery. Eyes underwent phaco if their IOP was controlled on 2 or less anti-glaucoma medications (AGMs). Eyes received concurrent filtration surgery if their IOP is controlled but requiring >3 AGMs or their IOP is not within the target range. Primary outcome measures were IOP and Kaplan-Meier survival. Primary definition of failure was IOP >21mmHg or <20% reduction below baseline after 1 month. Secondary outcome measures were AGMs and occurrence of complications; IOP spikes were defined as an elevation >20% over baseline).
121 eyes underwent phaco, 50 phaco-trab, and 156 phaco-AIT. There were no differences in baseline characteristics. IOP in the phaco group was lower up to 3.5y (P=0.008), for the phaco-AIT up to 3y (P=0.032), and during the entire follow-up period of 6.5y for the phaco-trabs (P=0.020). IOP reduction was highest in the phaco-trab and lowest in the phaco group. AGMs could be reduced in all groups. Besides that, severity and number of complications were higher in the phaco-trab group. Kaplan-Meier survival analysis shows comparable outcomes for all three procedures regardless of definition of failure up to 2y. After 2y, phaco-trab had a greater success rate compared to the phaco and phaco-AIT. Survival time varied between 28.2-33.7m for phaco, between 41.6-45.5m for phaco-trab, and between 22.4-26.6m for phaco-AIT, respectively. IOP spikes occurred in each group within 1m after surgery in 21.5 % in the phaco, 44.7% in the phaco-trab, and 8.9% in the phaco-AIT group, respectively. Most IOP spikes were less than 20mmHg.
Phaco-trab had a greater success rate and longer survival time with lower mean IOP. In the first two years the phaco-trab and phaco-AIT are equally effective with highest rate of early complications in the phaco-trab group. Phaco-AIT is reasonable to consider besides phaco-trab.
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