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N. R. Sabates, S. Teymoorian, R. Krishna; The Effect on Intraocular Pressure for Patients With Primary Open Angle Glaucoma That Have Either Vitreoretinal Surgery or Combination Vitreoretinal and Cataract Surgery. Invest. Ophthalmol. Vis. Sci. 2010;51(13):632.
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Intraocular pressure (IOP) reduction remains the primary target for ophthalmologists managing patients with primary open angle glaucoma (POAG). Once pharmacological therapy does not achieve IOP targets, laser procedures and glaucoma surgery are used. However, other surgical interventions such as cataract extraction have achieved some reduction in IOP. As popularity for combination cataract extraction (CE) with vitreoretinal (VR) surgery grows, the changes in IOP after performing these together is unknown. This study assesses the effect on IOP from pars plana vitrectomy (PPV) with and without combination CE for patients with uncomplicated VR disease and visually significant cataracts. This will provide clinicians guidance as to the impact of VR surgery on IOP in glaucoma patients.
IRB approved, retrospective chart review of consecutive, interventional cases.
The charts of patients with diagnosed POAG and co-existing uncomplicated VR pathology with and without visually significant cataracts that had VR surgery from an Ambulatory Surgical Center from February 2007 to December 2008 were collected and reviewed. Those patients with uncontrolled POAG needing changes in medication and/or surgery, proliferative retinopathy, or other significant ocular pathology were excluded. The remaining patients were then divided into the following two groups: Group 1 included those having combination PPV and CE, and Group 2 for those who received PPV only. IOP measurements on the clinic visit immediately prior to surgery along with 1 day, 1 week, 1 month, 3 month, and 6 months post-operative follow-up visits were recorded. SigmaStat 3.5 (Systat, Point Richmond, CA) was used for statistical analysis.
27 eyes from 27 patients met the inclusion criteria. 3 eyes were excluded because of the presence of proliferative diabetic retinopathy and 2 for uncontrolled POAG that required medication changes post-operatively. The reason for VR surgery in all cases was either macular pucker or hole. Group 1 patients all had visually significant cataracts. Pre-operative IOP for Group 1 (N=9) was 15.7+/-1.8 and for Group 2 (N=13) was 16.3+/-2.8mmHg (p=0.494). 6 months post-operative IOP for Group 1 was 11.5+/-1.4 and for Group 2 was 14.2+/-1.9 mmHg (p=0.048). Change in IOP was significant for both Group 1 (p<0.001) and Group 2 (p=0.035).
Combination VR with CE surgery and VR procedures alone both reduce IOP significantly in patients with POAG at 6 months. Combination VR and CE procedures provide additional IOP reduction.
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