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Oliver Yeh, Philip Chen; Refractive outcome after phacoemulsification following trabeculectomy. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4761. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate postoperative refraction in patients undergoing phacoemulsification after trabeculectomy
We reviewed the records of 86 eyes (72 patients) with glaucoma previously treated by trabeculectomy which subsequently underwent phacoemulsification by one surgeon (PC) between November 1999 and December 2011. Preoperative, intraoperative, and postoperative data were collected, including intraocular pressure (IOP) and refraction, ophthalmic biometry, predicted refraction, and postoperative refraction.
The mean patient age at phacoemulsification was 67.5 ± 12.9 years, with a mean time between trabeculectomy and phacoemulsification of 73 ± 98 months. The mean IOP was 12.0 ± 5.7 mmHg preoperatively on 0.5 ± 1.1 medications, and 11.4 ± 4.4 mmHg on 0.7 ± 1.1 medications at month 6 postoperatively. The median visual acuity was 20/40 preoperatively, and 20/20 at month 6 postoperatively. The average difference between the last postoperative manifest refraction and the predicted refraction was +0.025D, The difference between manifest and predicted refraction was > 1D in 37 eyes (large-difference, or LDiff group). The only significant pre- or intra-operative risk factor for LDiff was preoperative IOP, which was lower in the LDiff group (10.6 ± 4.6 vs 13.3 ± 6.4 mmHg, P = .041). Non-significant risk factors included age, preoperative refraction, number of preoperative glaucoma medications, axial length, type of biometry, formula used for intraocular lens calculation, and presence of an IOP spike postoperatively.
Lower pre-operative intraocular pressure is associated with a larger difference in final refraction in eyes having phacoemulsification after trabeculectomy.
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