JKOS Journal of the Korean Ophthalmological Society J Korean Ophthalmol Soc 0378-6471 2092-9374 Korean Ophthalmological Society 10.3341/jkos.2015.56.7.1075 jkos-56-1075 Original Article Treatment Outcome of Triple Procedure in Open-Angle Glaucoma and Angle-Closure Glaucoma KwonKye Yoon M.D BaeHyung Won M.D LeeSang Yeop M.D SeoSang Jin M.D LeeYun Ha M.D HongSa Min M.D, PhD SeongGong Je M.D, PhD KimChan Yun M.D, PhD The Institute of Vision Research, Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea Address reprint requests to Chan Yun Kim, MD, PhD Department of Ophthalmology, Severance Hospital, #50-1 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea Tel: 82-2-2228-3570, Fax: 82-2-312-0541 E-mail: kcyeye@yuhs.ac

∗ This study was presented as a narration at the 112th Annual Meeting of the Korean Ophthalmological Society 2014.

 08 2015 27 8 2015 56 7 1075 1080 21 11 2014 20 01 2015 26 05 2015 Copyright © 2015 Korean Ophthalmological Society 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Purpose:

To compare the surgical outcomes of triple procedure in patients with open-angle glaucoma and angle-closure glaucoma.

 Methods:

The patients who underwent triple procedures for open-angle glaucoma and angle-closure glaucoma and were fol-lowed up for more than 1 year postoperatively were retrospectively reviewed. Preoperative and postoperative visual acuity, intra-ocular pressure (IOP), visual field mean deviation, refractive error, number of medications, and complications were analyzed. The effect of surgery on IOP reduction and refractive error correction was compared.

 Results:

The IOP at 1 year postoperatively was 13.39 ± 2.25 mm Hg, 13.41 ± 2.79 mm Hg ( p = 0.981) and IOP reduction was 4.51 ± 6.35 mm Hg, 9.11 ± 8.27 mm Hg ( p = 0.042) in the open angle glaucoma group and angle closure glaucoma group, respectively. No patient in either group required reoperation due to uncontrolled IOP. The percentage of patients showing post-operative IOP reduction of at least 10% and 20% from baseline IOP was statistically higher in the angle-closure glaucoma group than in the open-angle glaucoma group. Prediction errors were -0.84 ± 0.88 D and -0.13 ± 0.65 D in the open-angle glaucoma group and angle-closure glaucoma group, respectively.

 Conclusions:

Triple procedure was effective in reducing IOP in both open-angle glaucoma and angle-closure glaucoma patients. The patients with angle-closure glaucoma showed better results in IOP control and refractive error correction compared with pa-tients with angle-closure glaucoma.

 Angle-closure glaucoma Open-angle glaucoma Triple procedure References ActonJSalmonJFScholtzRExtracapsular cataract extraction with posterior chamber lens implantation in primary angle-closure glaucomaJ Cataract Refract Surg1997239304 Ming ZhiZLimASYin WongTA pilot study of lens extraction in the management of acute primary angle-closure glaucomaAm J Ophthalmol20031355346 StrenkSAStrenkLMGuoSMagnetic resonance imaging of the anteroposterior position and thickness of the aging, accommodat-ing, phakic, and pseudophakic ciliary muscleJ Cataract Refract Surg20103623541 KookMSKimHBLeeSUShort-term effect of mitomycin-C augmented trabeculectomy on axial length and corneal astigmatismJ Cataract Refract Surg20012751823 TanHYWuSCRefractive error with optimum intraocular lens power calculation after glaucoma filtering surgeryJ Cataract Refract Surg20043025957 LoweRFAetiology of the anatomical basis for primary angle-clo-sure glaucoma. Biometrical comparisons between normal eyes and eyes with primary angle-closure glaucomaBr J Ophthalmol1970541619 GeorgeRPaulPGBaskaranMOcular biometry in occlud-able angles and angle closure glaucoma: a population based surveyBr J Ophthalmol200387399402 GoGBKimDWBaekNHIntraocular pressure change following cataract surgery in patient with high intraocular pressureJ Korean Ophthalmol Soc199334112834 Martinez-BelloCRodriguez-AresTPazosBChanges in anterior chamber depth and angle width after filtration surgery: a quantitative study using ultrasound biomicroscopyJ Glaucoma20009515 KarashevaGGoebelWKlinkTChanges in macular thick-ness and depth of anterior chamber in patients after filtration surgeryGraefes Arch Clin Exp Ophthalmol20032411705 FrancisBAWangMLeiHChanges in axial length follow-ing trabeculectomy and glaucoma drainage device surgeryBr J Ophthalmol2005891720 UretmenOAteşHAndaçKDeliBAxial length changes accom-panying successful nonpenetrating glaucoma filtration surgeryOphthalmologica2003217199203 ChanJCLaiJSThamCCComparison of postoperative re-fractive outcome in phacotrabeculectomy and phacoemulsification with posterior chamber intraocular lens implantationJ Glaucoma200615269 HusainRLiWGazzardGLongitudinal changes in anterior chamber depth and axial length in Asian subjects after trabeculec-tomy surgeryBr J Ophthalmol2013978526 CaporossiACaspriniFTosiGMBalestrazziALong-term results of combined 1-way phacoemulsification, intraocular lens im-plantation, and trabeculectomyJ Cataract Refract Surg19992516415 RockwoodEJLariveBHahnJOutcomes of combined cataract extraction, lens implantation, and trabeculectomy surgeriesAm J Ophthalmol200013070411 TowSLAungTOenFTSeahSKCombined phacoemulsifica-tion, intraocular lens implantation and trabeculectomy for chronic angle closure glaucomaInt Ophthalmol2001242839 Figures and Tables

The changes of IOP after triple procedure are shown at each time point. (A) OAG group. (B) AGC group. IOP = intra-ocular pressure; OAG = open angle glaucoma; ACG = angle closure glaucoma.

Characteristics of subjects who underwent triple procedure for OAG and ACG

OAG ACG p-value
No. of subjects 23 23
Sex (M:F) 18:5 10:13 0.033∗
Mean age ± SD (years) 69.00 ± 9.13 68.09 ± 8.47 0.727†
Mean IOP (mm Hg) 17.90 ± 5.96 22.91 ± 8.15 0.022†
Number of medications 2.43 ± 0.66 2.57 ± 0.73 0.528†
MD of visual field test (dB) -18.55 ± 9.52 -17.82 ± 9.42 0.849†
Mean follow-up period (years) 3.39 ± 1.69 2.92 ± 1.34 0.298†

Values are presented as mean ± SD.

OAG = open angle glaucoma; ACG = angle closure glaucoma; IOP = intraocular pressure; MD = mean deviaion.

p-value was derived from the Chi-square test;

p-values were derived from an independent t-test.

Postoperative 1 year outcome in OAG and ACG

OAG ACG p-value
No. of subjects 23 23
IOP (mm Hg) 13.39 ± 2.25 13.41 ± 2.79 0.981‡
△ IOP∗ (mm Hg) 4.51 ± 6.35 9.11 ± 8.27 0.042‡
Number of medications 0.65 ± 0.83 0.41 ± 0.67 0.287‡
Postoperative management (n, %) 13 (56.5) 10 (43.5) 0.556§
Reoperation (n, %) 0 (0) 0 (0) 1.000§
Prediction error† (D) -0.84 ± 0.88 -0.13 ± 0.65 0.008‡

Values are presented as mean ± SD.

OAG = open angle glaucoma; ACG = angle closure glaucoma; IOP = intraocular pressure.

Preoperative IOP - postoperative IOP;

Postoperative spherical equivalent - preoperative spherical equivalent;

p-values were derived from an independent t-test;

p-values were derived from the Chi-square test.

Postoperative IOP reduction in OAG and ACG

IOP reduction∗ OAG ACG p-value†
>10% 16 (60.9) 20 (90.9) 0.035
>20% 10 (43.5) 18 (81.8) 0.013
>30% 10 (43.5) 11 (50.0) 0.768

Values are presented as n (%).

IOP = intraocular pressure; OAG = open angle glaucoma; ACG = angle closure glaucoma.

100 × (preoperative IOP ‒ postoperative IOP)/preoperative IOP;

p-values were derived from the Chi-square test.

Postoperative complication in OAG and ACG

Complications OAG ACG
IOL dislocation - 1 (4.3)
Shallow anterior chamber - 1 (4.3)
Choroidal detachment 1 (4.3) -
Suspicious endophthalmitis 1 (4.3) -

Values are presented as n (%). OAG = open angle glaucoma; ACG = angle closure glaucoma;