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.