J Korean Ophthalmol Soc.  2012 Dec;53(12):1835-1845. 10.3341/jkos.2012.53.12.1835.

Comparison of Filtering-Bleb Survival and Intraocular Pressure between Combined Phacotrabeculectomy and Trabeculectomy in Primary Glaucomas

• Heo DW
• Kim CS

• KMID: 2216399
• DOI: http://doi.org/10.3341/jkos.2012.53.12.1835

Abstract

PURPOSE
To evaluate clinical results of combined phacotrabeculectomy (PHACO-TRAB) and trabeculectomy (TRAB) for primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG).
METHODS
Forty-two eyes of 42 patients with POAG and 60 eyes of 60 patients with PACG were studied retrospectively. Fifty-two patients underwent PHACO-TRAB and 50 patients underwent TRAB. The IOP, number of anti-glaucoma medications, and duration of filtering bleb survival for 3 years after surgery were compared.
RESULTS
For 12 months after surgery, the TRAB group maintained significantly lower IOP than the PHACO-TRAB group (p < 0.05, t-test), and there was no significant difference thereafter. The filtering bleb survival rate was significantly higher in the TRAB group during the study period. In patients with POAG, the TRAB group showed higher filtering bleb survival rate for 3 years (p = 0.016, log-rank test). However, in patients with PACG, there was no significant difference in filtering bleb survival between the 2 groups. In patients with POAG, the TRAB group maintained significantly lower IOP for 12 months after surgery, and there was no significant difference afterwards. In patients with PACG, the TRAB group maintained lower IOP only at 1, 3, and 6 months after surgery. However, the PHACO-TRAB group showed significantly lower IOP at 18 months and 36 months after surgery.
CONCLUSIONS
In patients with POAG, TRAB was more effective in lowering IOP and maintaining filtering bleb. However in patients with PACG, there was no difference in filtering bleb survival between the 2 groups. TRAB was more effective in maintaining IOP during the early period after surgery, but PHACO-TRAB was superior to TRAB beyond 1 year after surgery in patients with PACG.

Keyword

Filtering bleb; Intraocular pressure; Phacotrabeculectomy; Trabeculectomy

MeSH Terms

Blister
Eye
Glaucoma
Glaucoma, Angle-Closure
Glaucoma, Open-Angle
Humans
Intraocular Pressure
Retrospective Studies
Survival Rate
Trabeculectomy

Figure

• 

  Figure 1 The Kaplan-Meier survival curve for bleb survival (bleb score > 1) after trabeculectomy group (TRAB) and phacotrabeculectomy group (Phaco-TRAB). Cumulative survival in the trabeculectomy group: 86.5% at 12 months, 64.4% at 24 months, 43.4% at 36 month postoperatively. Cumulative survival in the Phacotrabeculectomy group: 46.2% at 12 months, 35.9% at 24 months, 30.2% at 36 months postoperatively. The difference between the 2 groups was statistically significant (p = 0.004, log rank test).

• 

  Figure 2 The Kaplan-Meier survival curve for bleb survival (bleb score > 1) as glaucoma type in Trabeculectomy group (TRAB, A) and in Phacotrabeculectomy group (Phaco-TRAB, B). (A) Cumulative survival in the POAG group: 100% at 12 months, 77.3% at 24 months, 55.2% at 36 months postoperatively. Cumulative survival in the PACG group: 74.1% at 12 months, 51.9% at 24 months, 30.7% at 36 months. The difference between the 2 groups was statistically significant (p = 0.016, log rank test). (B) Cumulative survival in the POAG group: 50.0% at 12 months, 42.9% at 24 months, 35.7% at 36 months postoperatively. Cumulative survival in the PACG group: 43.8% at 12 months, 31.6% at 24 months, 27.1% at 36 months. The difference between the 2 groups was not statistically significant (p = 0.397, log rank test).

• 

  Figure 3 The Kaplan-Meier survival curve for bleb survival (bleb score > 1) after trabeculectomy (TRAB) and phacotrabeculectomy (Phaco-TRAB) in Primary open angle glaucoma group (POAG, A) and in primary angle close glaucoma group (PACG, B). (A) Cumulative survival in the trabeculectomy group: 100% at 12 months, 77.3% at 24 months, 55.2% at 36 months postoperatively. Cumulative survival in the Phacotrabeculectomy group: 50.0% at 12 months, 42.9% at 24 months, 35.7% at 36 months. The difference between the 2 groups was statistically significant (p = 0.016, log rank test). (B) Cumulative survival in the trabeculectomy group: 74.1% at 12 months, 51.9% at 24 months, 30.7% at 36 months postoperatively. Cumulative survival in the Phacotrabeculectomy group: 43.8% at 12 months, 31.6% at 24 months, 27.1% at 36 months. The difference between the 2 groups was not statistically significant (p = 0.130, log rank test).

Reference

1. Lee YH, Yun YM, Kim SH, et al. Factors that influence intraocular pressure after cataract surgery in primary glaucoma. Can J Ophthalmol. 2009. 44:705–710.

2. Hayashi K, Hayashi H, Nakao F, Hayashi F. Changes in anterior chamber angle width and depth after intraocular lens implantation in eyes with glaucoma. Ophthalmology. 2000. 107:698–703.

3. Kitazawa Y, Kawase K, Matsushita H, Minobe M. Trabeculectomy with mitomycin. A comparative study with fluorouracil. Arch Ophthalmol. 1991. 109:1693–1698.

4. Kupin TH, Juzych MS, Shin DH, et al. Adjunctive mitomycin C in primary trabeculectomy in phakic eyes. Am J Ophthalmol. 1995. 119:30–39.

5. Scott IU, Greenfield DS, Schiffman J, et al. Outcomes of primary trabeculectomy with the use of adjunctive mitomycin. Arch Ophthalmol. 1998. 116:286–291.

6. Aggarwal SP, Hendeles S. Risk of sudden visual loss following trabeculectomy in advanced primary open-angle glaucoma. Br J Ophthalmol. 1986. 70:97–99.

7. Wygnanski-Jaffe T, Barak A, Melamed S, Glovinsky Y. Intraocular pressure increments after cataract extraction in glaucomatous eyes with functioning filtering blebs. Ophthalmic Surg Lasers. 1997. 28:657–661.

8. Dickens MA, Cashwell LF. Long-term effect of cataract extraction on the function of an established filtering bleb. Ophthalmic Surg Lasers. 1996. 27:9–14.

9. Longstaff S, Wormald RP, Mazover A, Hitchings RA. Glaucoma triple procedures; efficacy of intraocular pressure control and visual outcome. Ophthalmic Surg. 1990. 21:786–793.

10. Tsai HY, Liu CJ, Cheng CY. Combined trabeculectomy and cataract extraction versus trabeculectomy alone in primary angle-closure glaucoma. Br J Ophthalmol. 2009. 93:943–948.

11. Murthy SK, Damji KF, Pan Y, Hodge WG. Trabeculectomy and phacotrabeculectomy, with mitomycin-C, show similar two-year target IOP outcomes. Can J Ophthalmol. 2006. 41:51–59.

12. Choi YJ, Rhee DJ, Choi KR. Treatment outcome of phacotrabeculectomy and trabeculectomy in patients with cataracts and glaucoma. J Korean Ophthalmol Soc. 2011. 52:1308–1317.

13. Chang L, Thiagarajan M, Moseley M, et al. Intraocular pressure outcome in primary 5FU phacotrabeculectomies compared with 5FU trabeculectomies. J Glaucoma. 2006. 15:475–481.

14. Simmons ST, Litoff D, Nichols DA, et al. Extracapsular cataract extraction and posterior chamber intraocular lens implantation combined with trabeculectomy in patients with glaucoma. Am J Ophthalmol. 1987. 104:465–470.

15. Naveh N, Kottass R, Glovinsky J, et al. The long-term effect on intraocular pressure of a procedure combining trabeculectomy and cataract surgery, as compared with trabeculectomy alone. Ophthalmic Surg. 1990. 21:339–345.

16. Lochhead J, Casson RJ, Salmon JF. Long term effect on intraocular pressure of phacotrabeculectomy compared to trabeculectomy. Br J Ophthalmol. 2003. 87:850–852.

17. Chen CW. Enhanced intraocular pressure controlling effectiveness of trabeculectomy by local application of mitomycin-C. Trans Asia Pac Acad Ophthalmol. 1983. 9:172–177.

18. Wang WQ, Bellows AR, Guedes V, Hutchinson BT. Long-term evaluation of initial filtration surgery. Int Ophthalmol Clin. 1999. 39:133–138.

19. Gunning FP, Greve EL. Lens extraction for uncontrolled angle-closure glaucoma: long-term follow-up. J Cataract Refract Surg. 1998. 24:1347–1356.

20. Lowe RF. Aetiology of the anatomical basis for primary angle-closure glaucoma. Biometrical comparisons between normal eyes and eyes with primary angle-closure glaucoma. Br J Ophthalmol. 1970. 54:161–169.

21. Lee DA, Brubaker RF, Ilstrup DM. Anterior chamber dimensions in patients with narrow angles and angle-closure glaucoma. Arch Ophthalmol. 1984. 102:46–50.

22. Congdon NG, Youlin Q, Quigley H, et al. Biometry and primary angle-closure glaucoma among Chinese, white, and black populations. Ophthalmology. 1997. 104:1489–1495.

23. Marchini G, Pagliarusco A, Toscano A, et al. Ultrasound biomicroscopic and conventional ultrasonographic study of ocular dimensions in primary angle-closure glaucoma. Ophthalmology. 1998. 105:2091–2098.

24. Wilensky JT, Kaufman PL, Frohlichstein D, et al. Follow-up of angle-closure glaucoma suspects. Am J Ophthalmol. 1993. 115:338–346.