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Heo and Kim: Comparison of Filtering-Bleb Survival and Intraocular Pressure between Combined Phacotrabeculectomy and Trabeculectomy in Primary Glaucomas
Original Article
Journal of the Korean Ophthalmological Society

Journal of the Korean Ophthalmological Society 2012; 53(12): 1835-1845.

Published online: 17 December 2012

DOI: https://doi.org/10.3341/jkos.2012.53.12.1835

Comparison of Filtering-Bleb Survival and Intraocular Pressure between Combined Phacotrabeculectomy and Trabeculectomy in Primary Glaucomas

Dong Won Heo, MD1, Chang Sik Kim, MD, PhD1, 2

1Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Korea.

2Research Institute for Medical Science, Chungnam National University, Daejeon, Korea.

Address reprint requests to Chang Sik Kim, MD, PhD. Department of Ophthalmology, Chungnam National University Hospital, #282 Munhwa-ro, Jung-gu, Daejeon 301-721, Korea. Tel: 82-42-280-7606, Fax: 82-42-255-3745, kcs61@cnu.ac.kr

Received 17 April 2012       Accepted 19 October 2012

Copyright © 2012 The Korean Ophthalmological Society

Abstract

Purpose

To evaluate clinical results of combined phacotrabeculectomy (PHACO-TRAB) and trabeculectomy (TRAB) for primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG).

Methods

Forty-two eyes of 42 patients with POAG and 60 eyes of 60 patients with PACG were studied retrospectively. Fifty-two patients underwent PHACO-TRAB and 50 patients underwent TRAB. The IOP, number of anti-glaucoma medications, and duration of filtering bleb survival for 3 years after surgery were compared.

Results

For 12 months after surgery, the TRAB group maintained significantly lower IOP than the PHACO-TRAB group (p < 0.05, t-test), and there was no significant difference thereafter. The filtering bleb survival rate was significantly higher in the TRAB group during the study period. In patients with POAG, the TRAB group showed higher filtering bleb survival rate for 3 years (p = 0.016, log-rank test). However, in patients with PACG, there was no significant difference in filtering bleb survival between the 2 groups. In patients with POAG, the TRAB group maintained significantly lower IOP for 12 months after surgery, and there was no significant difference afterwards. In patients with PACG, the TRAB group maintained lower IOP only at 1, 3, and 6 months after surgery. However, the PHACO-TRAB group showed significantly lower IOP at 18 months and 36 months after surgery.

Conclusions

In patients with POAG, TRAB was more effective in lowering IOP and maintaining filtering bleb. However in patients with PACG, there was no difference in filtering bleb survival between the 2 groups. TRAB was more effective in maintaining IOP during the early period after surgery, but PHACO-TRAB was superior to TRAB beyond 1 year after surgery in patients with PACG.

Keywords: Filtering bleb, Intraocular pressure, Phacotrabeculectomy, Trabeculectomy

Figures and Tables

Figure 1
The Kaplan-Meier survival curve for bleb survival (bleb score > 1) after trabeculectomy group (TRAB) and phacotrabeculectomy group (Phaco-TRAB). Cumulative survival in the trabeculectomy group: 86.5% at 12 months, 64.4% at 24 months, 43.4% at 36 month postoperatively. Cumulative survival in the Phacotrabeculectomy group: 46.2% at 12 months, 35.9% at 24 months, 30.2% at 36 months postoperatively. The difference between the 2 groups was statistically significant (p = 0.004, log rank test).
jkos-53-1835-g001
Figure 2
The Kaplan-Meier survival curve for bleb survival (bleb score > 1) as glaucoma type in Trabeculectomy group (TRAB, A) and in Phacotrabeculectomy group (Phaco-TRAB, B). (A) Cumulative survival in the POAG group: 100% at 12 months, 77.3% at 24 months, 55.2% at 36 months postoperatively. Cumulative survival in the PACG group: 74.1% at 12 months, 51.9% at 24 months, 30.7% at 36 months. The difference between the 2 groups was statistically significant (p = 0.016, log rank test). (B) Cumulative survival in the POAG group: 50.0% at 12 months, 42.9% at 24 months, 35.7% at 36 months postoperatively. Cumulative survival in the PACG group: 43.8% at 12 months, 31.6% at 24 months, 27.1% at 36 months. The difference between the 2 groups was not statistically significant (p = 0.397, log rank test).
jkos-53-1835-g002
Figure 3
The Kaplan-Meier survival curve for bleb survival (bleb score > 1) after trabeculectomy (TRAB) and phacotrabeculectomy (Phaco-TRAB) in Primary open angle glaucoma group (POAG, A) and in primary angle close glaucoma group (PACG, B). (A) Cumulative survival in the trabeculectomy group: 100% at 12 months, 77.3% at 24 months, 55.2% at 36 months postoperatively. Cumulative survival in the Phacotrabeculectomy group: 50.0% at 12 months, 42.9% at 24 months, 35.7% at 36 months. The difference between the 2 groups was statistically significant (p = 0.016, log rank test). (B) Cumulative survival in the trabeculectomy group: 74.1% at 12 months, 51.9% at 24 months, 30.7% at 36 months postoperatively. Cumulative survival in the Phacotrabeculectomy group: 43.8% at 12 months, 31.6% at 24 months, 27.1% at 36 months. The difference between the 2 groups was not statistically significant (p = 0.130, log rank test).
jkos-53-1835-g003
Table 1
Comparison of baseline characteristics in combined phacotrabeculectomy group and trabeculectomy group
jkos-53-1835-i001

*Independent t-test; †Chi-square test. *Values are presented as mean ± SD.

Phaco-TRAB = phacotrabeculectomy; TRAB = trabeculectomy; IOP = intraocular pressure; DM = diabetic mellitus; POAG = primary open-angle glaucoma; PACG = primary angle-closure glaucoma.

Table 2
Comparison of baseline characteristics in primary angle-closure glaucoma and primary open angle glaucoma between combined phacotrabeculectomy group and trabeculectomy group
jkos-53-1835-i002

Values are presented as mean ± SD.

*Independent t-test; †Chi-square test.

POAG = primary open-angle glaucoma; PACG = primary angle-closure glaucoma; Phaco-TRAB = phacotrabeculectomy; TRAB = trabeculectomy; IOP = intraocular pressure; DM = diabetic mellitus; PAS = peripheral anterior synechiae.

Table 3
Change of mean intraocular pressure after surgery during the study period in phacotrabeculectomy group and trabeculectomy group
jkos-53-1835-i003

Values are presented as mean ± SD.

*Independent t-test; †Postoperative IOP's: significantly lower than baseline at all time intervals (p = 0.000, one-way ANOVA test).

Phaco-TRAB = phacotrabeculectomy; TRAB = trabeculectomy; IOP = intraocular pressure.

Table 4
Change of number of glaucoma medications after surgery during the study period in phacotrabeculectomy group and trabeculectomy group
jkos-53-1835-i004

*Independent t-test; †Postoperative number of glaucoma medications: significantly lower than baseline at all time intervals (p = 0.000, one-way ANOVA test).

Phaco-TRAB = phacotrabeculectomy; TRAB = trabeculectomy.

Table 5
Change in mean intraocular pressure after surgery during the study period in primary open-angle glaucoma group and primary angle-close glaucoma group by surgical method
jkos-53-1835-i005

*Independent t-test.

Phaco-TRAB = phacotrabeculectomy; TRAB = trabeculectomy; IOP = intraocular pressure; POAG = primary open-angle glaucoma; PACG = primary angle-closure glaucoma.

Table 6
Change of number of glaucoma medications after surgery during the study period in primary open angle glaucoma group and primary angle close glaucoma group by surgical method
jkos-53-1835-i006

*Independent t-test.

Phaco-TRAB = phacotrabeculectomy; TRAB = trabeculectomy; IOP = intraocular pressure; POAG = primary open angle glaucoma; PACG = primary angle close glaucoma.

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