Abstract
Purpose :
The successful long-term management of exfoliative glaucoma (XFG) patients with cataract remains a clinical challenge. One prospective study reported the ocular hypotensive effect of phacoemulsification was greater in patients with exfoliation syndrome (XFS) compared to control patients without XFS, in particular more pronounced in patients with XFG. The objective of this study is to determine whether previous modern phacoemulsification surgery affects surgical prognosis of primary trabeculectomy with MMC for XFG.
Methods :
This retrospective, consecutive study included 51 phakic eyes and 40 pseudophakic eyes (that had previously undergone phacoemulsification with temporal clear cornea incision) of XFG undergoing primary trabeculectomy with MMC. Surgical success was defined by intraocular pressure (IOP) < 18mm Hg and IOP reduction ≥ 20% with or without medication. Cumulative probabilities of success were compared using Kaplan-Meier survival analysis, and risk factors of surgical failure were analyzed with the Cox proportional hazards model.
Results :
The mean follow-up period was 44.7 ± 28.0 months. IOP decreased by 4.5 mm Hg in phakic eyes versus 11.1 mm Hg in pseudophakic eyes at last visits after surgery (p=0.005). Cumulative success rates were 78.4% at 1 year and 15.0% at 5 years for phakic eyes, and 85.0% and 31.5%, respectively, for pseudophakic eyes by complete success. Complete success rates were tended to be higher for pseudophakic eyes than for phakic eyes (p=0.068). Qualified success did not show a statistically significant difference (p=0.553). The risk factors associated with surgical failure were early postoperative hypotony (hazard ratio=2.81, p=0.016, complete success) and phakic status (hazard ratio=1.97, p=0.040, complete success).
Conclusions :
Long-term outcomes of primary trabeculectomy with MMC for XFG in eyes with prior phacoemulsification are comparable to or even better than those in phakic eyes. The later performing cataract surgery in previous trabeculectomized eyes seems to have had adversely effects on long-term outcomes of primary trabeculectomy. Therefore, this study suggests that performing phacoemulsification first and later trabeculectomy may be a better option if trabeculectomy is required on XFG patients with cataract.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.