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David Plemel, Renata Puertas, Keith Barton; Clinical outcomes of eyes with aqueous shunt implants after phacoemulsification. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3197.
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To assess the effect of cataract surgery on IOP and glaucoma medication usage in eyes previously implanted with aqueous shunts.
Consecutive interventional case series of eyes that underwent aqueous shunt implantation followed by phacoemulsification between 1998 and 2010. Eligible eyes were identified from a prospectively acquired database of aqueous shunt implants. Patients over the age of 16 with a minimum of 1-year follow-up after phacoemulsification were included. Patients with less than 3 months between shunt surgery and phacoemulsification, with phacoemulsification performed in combination with other ocular procedures involving the aqueous shunt, or with non-IOP related surgery within 1 year of phacoemulsification were excluded. Records of eligible patients were reviewed and the following collected: visual acuity, IOP, glaucoma medication usage and further glaucoma surgical procedures. Data was collected before phacoemulsification and postoperatively at 1 day; 1 week; 1, 3, 6, 12, 24 months; and at last follow-up. Comparisons were made using a two-tailed Student t test where a P value below 0.05 was used to determine statistical significance.
A total of 531 eyes underwent aqueous shunt implant during the study. Of these, 47 (8.85%) eyes subsequently underwent phacoemulsification and met the criteria. The mean age at shunt implantation was 53.0 years ± 13.7 (range 17-72 years). Phacoemulsification was performed 15.3 months ± 11.2 (mean ± SD)(range 4-60 months) after aqueous shunt insertion and followed-up for an average of 49.2 months ± 33.6 (mean ± SD)(range 12-150 months). Visual acuity improved from 1.13 logMAR ± 0.79 (mean ± SD) and was an average of 0.72 logMAR ± 0.79 (mean ± SD) at last follow-up. There was significant improvement to visual acuity at all times after phacoemulsification (P<0.05). IOP at last follow-up was 13.89mmHg ± 4.24 (mean ± SD) compared to 14.77mmHg ± 5.24 (mean ± SD) before phacoemulsification. IOP was significantly lower than before phacoemulsification at only the one week time-point (P=0.013). The mean number of glaucoma medications has not increased: 1 (0.85) ± 1.02 before phacoemulsification and 1 (1.04) ± 1.18 (mean ± SD) at last follow-up (P = 0.38).
Phacoemulsification in eyes previously implanted with aqueous shunts for glaucoma improves visual acuity without significantly altering the IOP or the number of medication used.
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