J Korean Ophthalmol Soc.  2018 Dec;59(12):1173-1180. 10.3341/jkos.2018.59.12.1173.

Refractive Error Induced by Combined Phacotrabeculectomy

• Lee JS
• Lee CE
• Park JH
• Seo S
• Lee KW

• KMID: 2428690
• DOI: http://doi.org/10.3341/jkos.2018.59.12.1173

Abstract

PURPOSE
We evaluated the postoperative accuracy of intraocular lens power prediction for patients undergoing phacotrabeculectomy and identified preoperative factors associated with refractive outcome in those with primary open-angle glaucoma (POAG).
METHODS
We retrospectively reviewed the medical records of 27 patients who underwent phacotrabeculectomy to treat POAG. We recorded all discrepancies between predicted and actual postoperative refractions. We compared the data to those of an age- and sex-matched control group that underwent uncomplicated cataract surgery during the same time period. Preoperative factors associated with the mean absolute error (MAE) were identified via multivariate regression analyses.
RESULTS
The mean refractive error of the 27 eyes that underwent phacotrabeculectomy was comparable to that of the 27 eyes treated via phacoemulsification (+0.02 vs. −0.01 D, p = 0.802). The phacotrabeculectomy group exhibited a significantly higher MAE (0.65 vs. 0.35 D, p = 0.035) and more postoperative astigmatism (−1.07 vs. −0.66 D, p = 0.020) than the phacoemulsification group. The preoperative anterior chamber depth (ACD) and the changes in the postoperative intraocular pressure (IOP) were significantly associated with a greater MAE after phacotrabeculectomy.
CONCLUSIONS
POAG treatment via combined phacoemulsification/trabeculectomy was associated with greater error in terms of final refraction prediction, and more postoperative astigmatism. As both a shallow preoperative ACD and a greater postoperative change in IOP appear to increase the predictive error, these two factors should be considered when planning phacotrabeculectomy.

Keyword

Astigmatism; Glaucoma; Phacotrabeculectomy; Refractive outcome

MeSH Terms

Anterior Chamber
Astigmatism
Cataract
Glaucoma
Glaucoma, Open-Angle
Humans
Intraocular Pressure
Lenses, Intraocular
Medical Records
Phacoemulsification
Refractive Errors*
Retrospective Studies

Figure

• 

  Figure 1 Distribution of the mean refractive error (preoperative target refraction subtracted from postoperative refraction) in the phacotrabeculectomy group and the phacoemulsification group. The phacotrabeculectomy group tends to have more refractive shift than phacoemulsification group. No. = number; D = diopter.

• 

  Figure 2 Schematic presentation of relationship between mean absolute error (MAE) and preoperative parameters. (A) Correlation between preoperative anterior chamber depth and the extent of MAE (｜ postoperative spherical equivalent refraction - preoperative predicted spherical equivalent refraction ｜). (B) Correlation between intraocular pressure (IOP) changes (preoperative IOP - postoperative IOP) and the extent of MAE in eyes that underwent phacotrabeculectomy.

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