One stage combined surgery versus two stage surgeries for coexisting glaucoma and cataract
Kumar Vinod Dushin Nicholai Vasilievich Isufaj Edmond
Ophthalmic unit of Skhodnya city hospital, Moscow region Department of ophthalmology, Russian people’s friendship university, Moscow, Russia.
Introduction
Surgical treatment for coexisting cataract and glaucoma
Two stage surgeriesTwo stage surgeriesGlaucoma surgeryGlaucoma surgery
SICS + IOLSICS + IOL
One stage surgery One stage surgery SICS + IOL + glaucoma surgerySICS + IOL + glaucoma surgery
Phaco + IOL + penetrating Phaco + IOL + penetrating glaucoma surgeryglaucoma surgery
Phaco + IOL + Non-penetratingPhaco + IOL + Non-penetrating glaucoma surgeryglaucoma surgery
««One-siteOne-site»»
««Two-siteTwo-site»»
Objective
To investigate the surgical outcome of one stage 2-site combined surgery for coexisting glaucoma and cataract and compare the results of this procedure with the results of cataract surgery in trabeculectomized eyes.
Participants
Patient demographicsone stage surgery
group (PIT)
two stage surgeries group (TPI)
Number of cases (male/female) 26 (12/14) 34 (19/15)
Age in years (Mean + SD) 72.6 + 6.7 72.8 + 6.5Visual acuity: prpl/0.01-0.03/0.04-0.09/0.1 4/8/4/10 8/7/3/16
Glaucoma stage: I/II/III a/b
2/18/622/4
0/22/1233/1
Complicating factors: lens swelling lens subluxation pseudo exfoliation
122
312
Methods Complete ophthalmic examination
Snellen’s visual acuity, slit-lamp examination, IOP readings with Maklakov’s tonometry
Inclusion criteria patients with open angle glaucoma, undergone
trabeculectomy procedure, operated by one surgeon and with a follow-up not less then 6 months
Outcome measures visual acuity; intraocular pressure and complications
arising intraoperatively, in early and late post-operative period
Statistical analysis P < 0.05 statistically significant
Surgical technique Two site surgery, fornix based conjunctival flap Clear corneal incision phacoemulsification of cataract Use of trypan blue
(25 cases, 96.1%-PTI;
32 cases, 94.1%-TPI)
iris-hooks
(18 cases, 69.2%-PTI;
19 cases, 55.9%-TPI) Phacoemulsifier system Galaxy – I, with peristaltic pump
(Appasamy associates, India) Stop and Chop, quick Chop US: pulse mode (8p/s) and micropulse mode (25p/s)
Video
Results (visual acuity, IOP)
IOP (last follow-up): Under control in both groups, no additional medication prescribed
Post operative
period
Number of cases
P valuePIT group TPI group
VA<0.5 VA>0.5 VA<0.5 VA>0.5
1st day 26 0 23 11 0.00011st week 22 4 16 18 0.00031th month 14 12 10 24 0.063rd month 12 14 12 22 0.26th month 12 14 12 22 0.2
Results (Intraoperative observations and
complications)
Intraoperative observations and complications
Number of casesP
PIT group TPI group
Surgical complication rate 15.4% 52.9% 0.001
Synechialysis required 0 11
0.001
Prolonged irrigation required because of petechial hemorrhage from pupil margin
2 8
PC rupture (vitreous loss) 0 2 (1)
CCC rupture 0 1
CTR implanted 2 1
Iris prolapsed from incision 1 1
US on time in sec. (Mean +/-SD) 101 +/- 25 104.5+/-32 0.62
Results (Early postoperative complications)
Early postoperative observations and complications
Number of cases (%)
PIT group TPI group
Hyphema 1 ( 3.8) 9 (26.5)1st degree Inflammation 2 ( 7.7) 1 ( 2.9)2nd degree Inflammation (exudative reaction) 6 (23.1) 8 (23.5)
Choroidal detachment 7 (26.9) 16 (47.1)Bleb leak 1 ( 3.8) 6 (17.6)High IOP 0 3 ( 8.8)Additional surgical intervention required: sclerectomy lens extraction + IOL extra suture applied
4 (15.4) 3 0 1
25 (73.5)
16 3 6
p 0.073
Results (Late postoperative complications)
Late postoperative observations and complications
Number of cases
PIT group TPI group
Deformed pupil 18 19
Anterior capsule fibrosis 2 1
Iridocyclitis 0 2
PCO requiring Nd:YAG laser capsulotomyTime range: 52 weeks - 1 weeks
0 3
Bullous keratopathy 0 1
p 0.814
Conclusion
One stage combined surgery is a safer and effective procedure for co-existing glaucoma and cataract.