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K.-R. Choi, S.-Y. Jea, L. R. Pasquale, D. J. Rhee; Comparison of Combined Phaco-Trabeculotomy and Phacotrabeculectomy in Patients With Cataract and Open Angle Glaucoma. Invest. Ophthalmol. Vis. Sci. 2010;51(13):592.
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To evaluate and compare the intraocular pressure (IOP) lowering effect and safety of combined phacoemulsification with ab interno trabeculotomy using TrabectomeR (PTE) versus Phacotrabeculectomy (PTB) in medically uncontrolled open angle glaucoma (OAG) patients with coexisting cataract.
We retrospectively reviewed all patients who underwent PTE and PTB between July 2007 and August 2009 by two surgeons. Inclusion criteria were the availability of greater than 6 months of follow up data and open angle glaucoma. Outcome measures were IOP, number of antiglaucoma medications, and occurrence of complications. Success and failure was defined according to the Tube Versus Trabeculectomy Study (TVTS).1 Data were collected at 3, 6, 9,12 months (mo) after surgery, PTE and PTB group (P=0.899).
75 eyes of 75 patients met inclusion criteria. Average follow up was 16.8±8.8 months in PTE group (n=45) and 22.3±12.7 months in PTB group (n=30). The mean preoperative IOPs were 18.5±6.0 mmHg and 18.6±5.0 mmHg for PTE and PTB groups, respectively (P=0.919). At 12 mo post-op, the IOP decreased to 13.5±3.2 mmHg for PTE group and 13.4±3.7 mmHg for PTE and PTB groups, respectively. The number of antiglaucoma medications was 2.5±0.96 and 2.9±0.8 for PTE and PTB groups, respectively, before surgery, and decreased to 1.9±1.3 and 1.7±1.1 for PTE and PTB group, respectively, at 12 months. There was no difference in postoperative failure rate and complications between two groups (p=0.899).An IOP spike (i.e. elevation of more than 10% baseline IOP) occurred postoperatively in 14 cases (31%) in PTB group and 8 cases (27%) in PTE group. There were 7 cases (15.5%) of postoperative hyphema for PTE group and 3 cases (10%) for PTB group.
PTE offered the same IOP lowering effect and decrease in antiglaucoma medication use as PTB. The failure rate of both groups was similar. The overall post operative complications were low both groups.Reference1. Gedde SJ, Schiffman JC, Feuer MJ, Herdon LW, Brandt JD, Budenz DL, and the tube versus trabeculectomy study group. Treatment Outcomes in the tube versus trabeculectomy study after one year of follow-up. Am J Ophthalmol. 2007;143:9-22.
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