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Leonardo Seidi Shigueoka, Jose Paulo C Vasconcellos, Vital P Costa; Phaconeedling versus phaco-retrabeculectomy in the treatment of patients with concomitant cataract and failed trabeculectomy. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3156.
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Combined cataract/glaucoma surgery is indicated in eyes with cataract and a failed trabeculectomy. IOP control following a failed trabeculectomy may be achieved with a needling procedure or a repeat trabeculectomy. The purpose of this study was to compare the efficacy and safety of phacoemulsification and needling with mytomicin C (phaconeedling) or phacoemulsification and a second trabeculectomy with mytomicin C (phaco-retrabeculectomy) in patients with cataract and a failed trabeculectomy.
A retrospective, nonrandomized and comparative study of 22 eyes of 22 patients who underwent phaconeedling (n=10) or phaco-retrabeculectomy (n=12). Postoperative outcome measures included change in visual acuity (VA), intraocular pressure (IOP), the number of antiglaucoma medications, and postoperative complications.
There were no differences in age, sex, ethnicity, type of glaucoma or number of previous glaucoma surgeries between the groups (p>0.05). Preoperatively, mean±SD logMAR VA (1.38±0.6 versus 1.22±0.7, p=0.94) and IOP (15.75±5.2 versus 16.84±6.8, p=0.66) were similar, but the number of anti-glaucoma medications was significantly higher for phaco-retrabeculectomy group (3.08±0.7 versus 3.81±0.7, p=0.03). Patients were followed for a mean of 6.18±4.3 months (range: 2 to 12 months). After 6 months, mean IOPs in the phaconeedling and phaco-retrabeculectomy were 9.66±3.5 mmHg and 14.77±6.83 mmHg, respectively (p=0.25), and the number of antiglaucoma medications were 0.33±0.5 and 1.00±1.3, respectively (p=0.42). There were no significant differences regarding postoperative complications between the groups (p=0.54).
Phaconeedling is an effective and safe surgical option for eyes with cataract and a failed trabeculectomy.
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