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Rajvi Mehta, Shizuka Tomatsu, Dingcai Cao, Alexander Pleet, Alexander Mokhur, Ahmad Aref, Thasarat S Vajaranant; Refractive outcomes for combined phacoemulsification and glaucoma drainage procedure. Invest. Ophthalmol. Vis. Sci. 2019;60(9):3757.
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© ARVO (1962-2015); The Authors (2016-present)
This study was designed to evaluate the refractive outcomes of combined cataract extraction and glaucoma drainage device surgery.
A retrospective chart review of patients undergoing combined phacoemulsification with glaucoma drainage device surgery (Baerveldt, Abbott Medical, Abbott Park (IL) or Ahmed valve, New World Medical, Rancho Cucamonga (CA)) between June 2009 and August 2017 was performed. The main outcome measure evaluated was whether or not spherical equivalent between -1.00D to +1.00D from target refraction was achieved at 3 to 6 months postoperatively. For secondary outcomes, we further assessed demographic and clinical characteristics that may have affected refractive outcome.
The final analysis included 42 eyes of 38 patients who underwent combined phacoemulsification and glaucoma drainage device surgery. A refractive outcome of spherical equivalent between -1.00D and +1.00D of the target refraction was achieved in 30 of 42 eyes (71.43%) at 3 to 6 months after surgery. For the remaining 12 eyes with difference in refractive outcome greater than 1.00D from target refraction, regression analysis (Figure 1) indicated that pre-operative axial length (AL) was positively related [0.28(0.11), p = 0.022] to refractive outcome in these eyes; however, in eyes with difference between -1.00D and +1.00D of the target refraction, pre-operative AL was negatively related [-0.15(0.07), p = 0.037] to refractive outcome. In a subset of 22 eyes with available preoperative keratometry measures, a mean 0.27D (SD=0.81; range, -1.49 to 1.42) of corneal astigmatism was induced by combined surgery. Age, central corneal thickness, pre-operative intraocular pressure (IOP) and post-operative IOP did not significantly affect refractive outcomes in the sample.
Refractive outcomes within 1.00D of the target refraction were achieved in the majority of patients when using a combined surgical approach. Axial length was found to be a risk factor among patients with refractive change greater than 1.00D from target refraction.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
Figure 1: Regression analysis showing relation between difference in refractive outcome and pre-operative intraocular pressure (IOP0), post-operative IOP at 1 month (IOP1), 3 months (IOP3), 6 months (IOP6) and 12 months (IOP12) after surgery, and pre-operative axial length
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