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Benjamin T Whigham, Aliza Aziz, Wei Hou, Inci Dersu; Outcomes of resident-performed trabeculectomies with combined cataract surgery. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4938.
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One variable in glaucoma surgery is whether it is combined with a second procedure, most often cataract extraction with intraocular lens placement. Here we examine the effect of combined cataract surgery in trabeculectomies performed by residents.
The study was a retrospective chart review. Included was primary open-angle glaucoma patients age ≥18 years with IOP >16 and <40 mmHg who received a resident-performed trabeculectomy between 1/2006 and 7/2012. Only trabeculectomies without prior glaucoma surgery were included. We recorded intraocular pressure (IOP) and number of glaucoma drops pre-op, 3 (±1) months post-op, and 5 (±0.5) years post-op. Other outcomes were bleb dysfunction (over or under filtration) by 3 months, cumulative reoperation rates by 5 years, and development of no light-perception (NLP) vision. Outcomes were compared between trabeculectomies with and without combined cataract extraction (CE). Statistical analyses were performed with two-tailed Student t-test and Fisher’s exact test.
231 filtering glaucoma surgeries were identified in the study period. 191 were excluded. Primary reasons were incomplete records (44%), failure to follow to 5 years (37%), or secondary forms of glaucoma (12%). Of the 40 trabeculectomies to meet all inclusion criteria, 28 were combined with CE and 12 were not. Groups were not significantly different in terms of age (p=0.11), gender (p=0.49), ethnicity (p=1.0), diabetes (p=0.49) hypertension (p=0.99), and average preoperative IOP (p=0.81). At 3 months post-op IOP decreased by 38±25% in the CE group and 49±15% in the non-CE group (p=0.17). At 5 years IOP reduction was 38±26% for CE and 40±26% for non-CE. Glaucoma drops for CE and non-CE groups were 2.9±0.5 and 2.8±0.9 pre-op (p = 0.91), 1.8±1.1 and 1.8±1.4 at 3 months (p = 0.92), and 2.4±0.9 and 1.8±1.5 at 5 years (p = 0.41). No included patients progressed to NLP vision. Early bleb dysfunction was more common in CE (61%) than non-CE (33%) trabeculectomies but not significantly (p=0.17). Reoperation rates were 21.4% in the CE group and 16.7% in the non-CE group (p=1.0) at 5 years.
Resident-performed trabeculectomies appear to have similar 5-year outcomes when combined with cataract surgery. A limitation of our study was decreased power due to few patients with long-term follow up.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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