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K. Nouri-Mahdavi, C. Supawavej, S. K. Law, J. Caprioli; Comparison of Tonometric Results of Initial Trabeculectomy With Mitomycin C After Prior Clear-Cornea Phacoemulsification to Outcomes in Phakic Eyes. Invest. Ophthalmol. Vis. Sci. 2010;51(13):615.
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To evaluate tonometric outcomes after initial trabeculectomy with Mitomycin C in eyes with prior temporal clear-cornea phacoemulsification and compare results to those in a control group of phakic eyes.
We retrospectively reviewed two cohorts of patients that underwent initial trabeculectomy with MMC at UCLA’s Glaucoma Division between October 2000 and June 2009. The two groups consisted of 35 eyes (of 35 patients) that underwent clear-cornea phacoemulsification before trabeculectomy and a group of phakic eyes (35 eyes of 35 patients) matched for surgeon, time of glaucoma surgery (±1 year), age (±10 years) and race. The primary outcome measures were qualified success rate (success rate with or without medications) and IOP control. Criteria A and B for success consisted of a final IOP 20% IOP reduction vs. IOP 25% IOP reduction, respectively.
Trabeculectomy was done an average (± SD) of 2.7 ± 2.1 years after cataract surgery in the pseudophakic group. Preoperative IOPs in the pseudophakic and phakic groups were 21.7 ± 5.9 and 18.8 ± 5.3 mmHg, respectively, and decreased to 11.6 ± 4.5 and 12.8 ± 4.3 mmHg at 12 months, and 10.6 ± 4.8 and 12.6 ± 4.1 mmHg at 2 years (p>0.05 for both postoperative between-group comparisons). Based on criteria A, the one-year and two-year survival rates were 88% (95% CI: 68-96%) and 83% (95% CI: 62-93%) for the pseudophakic group, respectively, as opposed to 88% (95% CI: 68-96%) and 84% (95% CI: 62-94%) in phakic eyes (p=0.41; log-rank test). Based on criteria B, the one-year and two-year survival rates were 88% (95% CI: 70-96%) and 80% (95% CI: 59-92%) for the pseudophakic group, respectively, as opposed to 81% (95% CI: 60-92%) and 76% (95% CI: 54%-89%) in phakic eyes (p=0.2; log-rank test). Sixteen phakic patients underwent subsequent cataract surgery a median of 9 months after trabeculectomy. One patient in the pseudophakic group and two patients in the phakic group required repeat glaucoma surgery.
Tonometric outcomes after initial trabeculectomy with MMC in eyes with prior clear-cornea phacoemulsification are comparable to results in phakic eyes. A history of clear-cornea phacoemulsification does not appear to significantly increase chances of failure in eyes that subsequently undergo trabeculectomy.
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