J Korean Ophthalmol Soc.  2012 Apr;53(4):544-552.

Phacoemulsification versus Combined Phacotrabeculectomy in Closed-Angle Patients with Re-Elevated Intraocular Pressure after Peripheral Iridotomy

• Bae S
• Hyung S
• Kim W
• Kim CS

Abstract

PURPOSE
To investigate the clinical courses between phacoemulsification (PE) and PE with combined trabeculectomy (phacotrabeculectomy, PETL) in closed-angle patients with re-elevated intraocular pressure (IOP) after laser peripheral iridotomy (LPI).
METHODS
Closed-angle patients whose IOP re-elevated between 19 and 38 mm Hg after LPI were included. Medical records of 26 patients in the PE group and 21 patients in the PETL group who were followed for more than 12 months after surgery were reviewed for clinical course.
RESULTS
The IOP courses after surgery showed no statistical difference during the study period except at 1 and 7 days after surgery, in which IOP in the PETL group were lower than that in the PE group. The number of anti-glaucoma drugs also showed no significant difference except at 6 months, when the number was greater in the PE group. Success rates for IOP below 18 mm Hg at 3 years were 96.2% in the PE group, higher than the 69.8% in the PETL group (Log Rank test, p = 0.015). Postoperative complications were found in 2 patients in the PE group and in 8 patients in the PETL group (Fisher's exact test, p = 0.028).
CONCLUSIONS
We suggest that PE is a viable surgical alternative to PETL in closed-angle patients who have mildly re-elevated IOP after LPI.

Keyword

Closed-angle; Laser peripheral iridotomy; Phacoemulsification; Phacotrabeculectomy

MeSH Terms

Humans
Intraocular Pressure
Medical Records
Phacoemulsification
Postoperative Complications
Trabeculectomy

Figure

• 

  Figure 1 Profiles of change in intraocular pressure in phacoemulsificatin (PE) group and phaco-trabeculectomy (PETL) group. Postoperative intraocular pressure course showed no statistically significant difference between the two groups during follow-up except for 1-day and 7-day after surgery in which intraocular pressure in PETL group were lower than PE group (p = 0.04 and 0.01, respectively, Mann-Whitney test). Pre-op = preoperative; PE = phacoemulsification; PETL = phacotrabeculectomy. *p < 0.05 compared with both groups.

• 

  Figure 2 Profiles of change in the number of antiglaucoma medications in phacoemulsification (PE) group and phaco-trabeculectomy (PETL) group. Number of postoperative antiglaucoma drug showed no statistically significant difference between 2 groups during follow-up except at 3, 6 months after surgery in which the number was significantly greater in PE group (both p = 0.04, Mann-Whitney test). Pre-op = preoperative; PE = phacoemulsification; PETL = phacotrabeculectomy. *p < 0.05 compared with both groups.

• 

  Figure 3 Kaplan-Meier survival curve. Success rates of IOP maintenance below 18 mm Hg were 96.2% after 9 months in PE group and at 3, 9, and 15 months, 85.7%, 76.2%, and 69.8% in PETL group. Survival rate in PE group was higher than that in PETL group with statistical significance (Log Rank test, p = 0.015). PE = phacoemulsification; PETL = phacotrabeculectomy.

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