Abstract
Purpose: :
since cataract surgery may compromise the success of previous trabeculectomy, we evaluated whether the outcome of viscocanalostomy may be influenced by subsequent phacoemulsification as well.
Methods: :
we retrieved the medical records of all the patients who underwent viscocanalostomy in our University Hospital between September 2001 and August 2004, due to uncontrolled IOP (> 21 mmHg) despite maximum tolerated medical therapy. Among those who displayed a complete success (IOP ≤ 21 mmHg on no medication), we selected all those who had undergone a subsequent temporal clear cornea phacoemulsification, at least three months after glaucoma surgery. Only patients with at least a 12–month follow–up after cataract extraction were included. If both eyes had been operated on, only right eyes were considered. Main outcome measure was the survival of an IOP ≤ 21 mmHg on no medication 12 months after phacoemulsification, either on no medication (complete success) or on medication (qualified success). Failure was defined as the need for further glaucoma surgery due to uncontrolled IOP decompensation. Secondary outcome measure was the difference between preoperative IOP and the IOP measured 12 months after cataract extraction, or the last IOP value available on no medication if any had to be added.
Results: :
in the three–year time span considered we operated on 107 patients, and 92 of them had a complete 3–month success. Eighteen of these (19.5%) underwent subsequent phacoemulsification. All cataract extractions were uneventful with in–the–bag foldable IOL implantation. One patient was excluded from the analysis because despite an IOP of 19 mmHg on no medication he was medicated again and then submitted to MMC trabeculectomy due to VF deterioration. Among the 17 patients left, a complete success 12 months after cataract removal was found in 15 (88.2%), and a qualified success in 2 (11.8%), and these were well controlled on one single agent. No patient had to be further operated for uncontrolled IOP. Mean pre–phaco and 1–year post–phaco IOPs were 13.1±3.3 mmHg and 14.6±4.4 mmHg respectively (n.s.).
Conclusions: :
the outcome of viscocanalostomy seems rather unaffected by uneventful subsequent temporal clear cornea phacoemulsification with foldable in–the–bag IOL implantation.
Keywords: clinical (human) or epidemiologic studies: outcomes/complications • cataract • intraocular pressure