Comparative Study of Surgical Outcomes of Twin-site Phacotrabeculectomy with Mitomycin C in Primary Open-angle Glaucoma Versus Primary Angle-closure Glaucoma

Overview

Journal Indian J Ophthalmol

Specialty Ophthalmology

Date 2023 Oct 23

PMID 37870019

Authors

Devendra Maheshwari

Madhavi Ramanatha Pillai

Swathi Kanduri

Indu J Nair

Mohideen Abdul Kader

Rengappa Ramakrishnan

Affiliations

Soon will be listed here.

Abstract

Purpose: To compare the surgical outcomes of twin-site phacotrabeculectomy with Mitomycin C (MMC) in primary open-angle glaucoma (POAG) versus primary angle-closure glaucoma (PACG).

Methods: Prospective, comparative, observational study. Patients with visually significant cataract and primary glaucoma were divided into two groups: POAG and PACG. They underwent twin-site phacotrabeculectomy with MMC and followed up on days 1, 15, 1 month, 6 months, and 12 months. Baseline and follow-up visits were compared to find the differences in intraocular pressure (IOP), antiglaucoma medications (AGM), success rates, anterior chamber depth (ACD), and axial length (AXL).

Results: There were 50 eyes each in POAG and PACG groups. Mean IOP reduction from baseline to 12 months (21.22 ± 6.0 to 11.40 ± 2.8-POAG group vs 24.16 ± 7.6 to 12.42 ± 3.2-PACG group) was statistically significant in both groups (P < 0.001), but no significant difference between groups (P = 0.095). There was a statistically significant decline in the number of AGM in POAG [1.66 (0.7) to 0.38 (0.7), P < 0.001] and PACG [2.10 (0.7) to 0.70 (0.8), P < 0.001]; the decline was more in POAG (P = 0.012) at last visit. Probability of overall (complete and qualified) success at 12 months postop was 72.0% [95% confidence interval (CI): 57.4-82.4] in PACG and 84.0% (95% CI: 70.5-91.7) in POAG group. There was a significant increase in ACD and a decrease in AXL in both groups (P < 0.001). More interventions were required in the PACG group (38, P = 0.012).

Conclusion: Phacotrabeculectomy with MMC causes a significant reduction in IOP and improvement in biometric parameters in both POAG and PACG. Patients with PACG required more postoperative interventions, while a lesser number of antiglaucoma medications were needed in POAG patients.

References

Poon L, Lai I, Lee J, Tsai J, Lin P, Teng M . Comparison of surgical outcomes after phacotrabeculectomy in primary angle-closure glaucoma versus primary open-angle glaucoma. Taiwan J Ophthalmol. 2017; 5(1):28-32. PMC: 5602719. DOI: 10.1016/j.tjo.2015.01.001. View

Vaideanu D, Mandal K, Hildreth A, Fraser S, Phelan P . Visual and refractive outcome of one-site phacotrabeculectomy compared with temporal approach phacoemulsification. Clin Ophthalmol. 2009; 2(3):569-74. PMC: 2694017. DOI: 10.2147/opth.s1764. View

Migdal C, Gregory W, Hitchings R . Long-term functional outcome after early surgery compared with laser and medicine in open-angle glaucoma. Ophthalmology. 1994; 101(10):1651-6; discussion 1657. DOI: 10.1016/s0161-6420(94)31120-1. View

Cunliffe I, Dapling R, West J, Longstaff S . A prospective study examining the changes in factors that affect visual acuity following trabeculectomy. Eye (Lond). 1992; 6 ( Pt 6):618-22. DOI: 10.1038/eye.1992.133. View

. The Advanced Glaucoma Intervention Study: 8. Risk of cataract formation after trabeculectomy. Arch Ophthalmol. 2001; 119(12):1771-9. DOI: 10.1001/archopht.119.12.1771. View

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(4):698-703. DOI: 10.1016/s0161-6420(00)00007-5. View

Prata T, Ushida M, Dorairaj S . Cataract surgery alone cannot be considered an IOP-lowering procedure for open-angle glaucoma patients: an evidence-based perspective. Arq Bras Oftalmol. 2015; 78(5):V-VI. DOI: 10.5935/0004-2749.20150072. View

Vijaya L, George R, Baskaran M, Arvind H, Raju P, Ramesh S . Prevalence of primary open-angle glaucoma in an urban south Indian population and comparison with a rural population. The Chennai Glaucoma Study. Ophthalmology. 2007; 115(4):648-654.e1. DOI: 10.1016/j.ophtha.2007.04.062. View

Tham Y, Li X, Wong T, Quigley H, Aung T, Cheng C . Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology. 2014; 121(11):2081-90. DOI: 10.1016/j.ophtha.2014.05.013. View

10.

Klein B, Klein R, Linton K . Prevalence of age-related lens opacities in a population. The Beaver Dam Eye Study. Ophthalmology. 1992; 99(4):546-52. DOI: 10.1016/s0161-6420(92)31934-7. View

11.

Burr J, Azuara-Blanco A, Avenell A, Tuulonen A . Medical versus surgical interventions for open angle glaucoma. Cochrane Database Syst Rev. 2012; 9):CD004399. PMC: 11707325. DOI: 10.1002/14651858.CD004399.pub3. View

12.

Cho H, Kee C . Population-based glaucoma prevalence studies in Asians. Surv Ophthalmol. 2014; 59(4):434-47. DOI: 10.1016/j.survophthal.2013.09.003. View

13.

Lai J, Tham C, Chan J, Lam D . Phacotrabeculectomy in treatment of primary angle-closure glaucoma and primary open-angle glaucoma. Jpn J Ophthalmol. 2004; 48(4):408-11. DOI: 10.1007/s10384-003-0075-2. View

14.

Casson R, Rahman R, Salmon J . Phacoemulsification with intraocular lens implantation after trabeculectomy. J Glaucoma. 2002; 11(5):429-33. DOI: 10.1097/00061198-200210000-00011. View

15.

Ramakrishnan R, Nirmalan P, Krishnadas R, Thulasiraj R, Tielsch J, Katz J . Glaucoma in a rural population of southern India: the Aravind comprehensive eye survey. Ophthalmology. 2003; 110(8):1484-90. DOI: 10.1016/S0161-6420(03)00564-5. View

16.

Murthy S, Damji K, Pan Y, Hodge W . Trabeculectomy and phacotrabeculectomy, with mitomycin-C, show similar two-year target IOP outcomes. Can J Ophthalmol. 2006; 41(1):51-9. DOI: 10.1016/S0008-4182(06)80067-0. View

17.

Lai J, Tham C, Chan J . The clinical outcomes of cataract extraction by phacoemulsification in eyes with primary angle-closure glaucoma (PACG) and co-existing cataract: a prospective case series. J Glaucoma. 2005; 15(1):47-52. DOI: 10.1097/01.ijg.0000196619.34368.0a. View

18.

Rao H, Maheshwari R, Senthil S, Prasad K, Garudadri C . Phacotrabeculectomy without mitomycin C in primary angle-closure and open-angle glaucoma. J Glaucoma. 2010; 20(1):57-62. DOI: 10.1097/IJG.0b013e3181ca7f65. View

19.

Shingleton B, Gamell L, ODonoghue M, Baylus S, KING R . Long-term changes in intraocular pressure after clear corneal phacoemulsification: normal patients versus glaucoma suspect and glaucoma patients. J Cataract Refract Surg. 1999; 25(7):885-90. DOI: 10.1016/s0886-3350(99)00107-8. View

20.

Ahmadzadeh A, Kessel L, Subhi Y, Bach-Holm D . Comparative Efficacy of Phacotrabeculectomy versus Trabeculectomy with or without Later Phacoemulsification: A Systematic Review with Meta-Analyses. J Ophthalmol. 2021; 2021:6682534. PMC: 7896844. DOI: 10.1155/2021/6682534. View