Purpose:
To analyse the outcomes of two types of combined filtrating glaucoma surgery combined with cataract extraction in terms of visual acuity (VA) change, intraocular pressure (IOP) control, complication rate and need for further interventions.
Methods:
Retrospective case-note review of consecutive eyes operated with either non-penetrating deep sclerectomy (NPDS) or trabeculectomy (TBC) combined with phacoemulsification and intraocular lens implantation (PIOL) by two experienced surgeons at a single tertiary centre from 1 January 2008 until 31 December 2009. Complication rates, VA and postoperative management analysis was carried out in all cases. IOP control analysis included only uncomplicated cases with at least 360 days of follow-up.
Results:
DescriptionThere were 53 eyes, 42 of which (79.2%) received NPDS combined with PIOL. There were no significant demographic differences. 31 of the eyes had primary open angle glaucoma, 17 pseudoexfoliative glaucoma, 3 chronic angle-closure glaucoma and 1 neovascular glaucoma. There was a higher proportion (54.5% vs 28.6%) of pseudoexfoliative glaucomas in TBC cases. 1 case with NPDS had posterior capsule rupture. 2 cases of NPDS had minor problems with Descemet’s membrane dissection and 1 further case was converted to TBC due to membrane perforation. Median preoperative VA was 6/30 for TBC and 6/15 for NPDS. Mean preoperative IOP was 24.8 for NPDS and 23.4 for TBC. Median number of pressure-lowering drugs was 3 for NPDS and 2 for TBC.Visual acuityMedian postoperative VA was 6/7.5 for NPDS-PIOL and 6/10 for TBC-PIOLPressure controlMean IOP at 12 months were 15.4mmHg for NPDS and 14.9mmHg for TBC, no statistically significant difference (p = 0.42). 73.2% NPDS had no associated drugs after 12 months, whereas only 40% of patients with TBC were free from drops in this period (p = 0.044)Post-operative course24.4% of eyes with NPDS necessitated goniopuncture and 31.7% suturolysis compared with 20% of eyes that received TBC. 11.2% of eyes with NPDS developed postoperative hyphaema vs 18.2% of eyes with TBC. There were no instances of hypotony.
Conclusions:
Both operations seem to provide satisfactory pressure control however NPDS seems to be more effective on its own. NPDS requires more postoperative attention to maintain its function.
Keywords: clinical (human) or epidemiologic studies: outcomes/complications • intraocular pressure • small incision cataract surgery