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Bae, Hyung, Kim, and Kim: Phacoemulsification versus Combined Phacotrabeculectomy in Closed-Angle Patients with Re-Elevated Intraocular Pressure after Peripheral Iridotomy
Original Article
Journal of the Korean Ophthalmological Society

Journal of the Korean Ophthalmological Society 2012; 53(4): 544-552.

Published online: 17 April 2012

DOI: https://doi.org/10.3341/jkos.2012.53.4.544

Phacoemulsification versus Combined Phacotrabeculectomy in Closed-Angle Patients with Re-Elevated Intraocular Pressure after Peripheral Iridotomy

Sinwoo Bae, MD1, Sungmin Hyung, MD, PhD1, Woojin Kim, MD2, Chang Sik Kim, MD, PhD2

1Department of Ophthalmology, Chungbuk National University College of Medicine, Cheongju, Korea.

2Department of Ophthalmology, Chungnam National University School of Medicine, Daejeon, Korea.

Address reprint requests to Sungmin Hyung, MD, PhD. Department of Ophthalmology, Chungbuk National University Hospital, #776 1Sunhwan-ro, Heungdeok-gu, Cheongju 361-711, Korea. Tel: 82-43-269-6368, Fax: 82-43-264-5263, smh@chungbuk.ac.kr

Received 12 April 2011       Accepted 25 February 2012

Copyright © 2012 The Korean Ophthalmological Society

Abstract

Purpose

To investigate the clinical courses between phacoemulsification (PE) and PE with combined trabeculectomy (phacotrabeculectomy, PETL) in closed-angle patients with re-elevated intraocular pressure (IOP) after laser peripheral iridotomy (LPI).

Methods

Closed-angle patients whose IOP re-elevated between 19 and 38 mm Hg after LPI were included. Medical records of 26 patients in the PE group and 21 patients in the PETL group who were followed for more than 12 months after surgery were reviewed for clinical course.

Results

The IOP courses after surgery showed no statistical difference during the study period except at 1 and 7 days after surgery, in which IOP in the PETL group were lower than that in the PE group. The number of anti-glaucoma drugs also showed no significant difference except at 6 months, when the number was greater in the PE group. Success rates for IOP below 18 mm Hg at 3 years were 96.2% in the PE group, higher than the 69.8% in the PETL group (Log Rank test, p = 0.015). Postoperative complications were found in 2 patients in the PE group and in 8 patients in the PETL group (Fisher's exact test, p = 0.028).

Conclusions

We suggest that PE is a viable surgical alternative to PETL in closed-angle patients who have mildly re-elevated IOP after LPI.

Keywords: Closed-angle, Laser peripheral iridotomy, Phacoemulsification, Phacotrabeculectomy

Figures and Tables

Figure 1
Profiles of change in intraocular pressure in phacoemulsificatin (PE) group and phaco-trabeculectomy (PETL) group. Postoperative intraocular pressure course showed no statistically significant difference between the two groups during follow-up except for 1-day and 7-day after surgery in which intraocular pressure in PETL group were lower than PE group (p = 0.04 and 0.01, respectively, Mann-Whitney test). Pre-op = preoperative; PE = phacoemulsification; PETL = phacotrabeculectomy. *p < 0.05 compared with both groups.
jkos-53-544-g001
Figure 2
Profiles of change in the number of antiglaucoma medications in phacoemulsification (PE) group and phaco-trabeculectomy (PETL) group. Number of postoperative antiglaucoma drug showed no statistically significant difference between 2 groups during follow-up except at 3, 6 months after surgery in which the number was significantly greater in PE group (both p = 0.04, Mann-Whitney test). Pre-op = preoperative; PE = phacoemulsification; PETL = phacotrabeculectomy. *p < 0.05 compared with both groups.
jkos-53-544-g002
Figure 3
Kaplan-Meier survival curve. Success rates of IOP maintenance below 18 mm Hg were 96.2% after 9 months in PE group and at 3, 9, and 15 months, 85.7%, 76.2%, and 69.8% in PETL group. Survival rate in PE group was higher than that in PETL group with statistical significance (Log Rank test, p = 0.015). PE = phacoemulsification; PETL = phacotrabeculectomy.
jkos-53-544-g003
Table 1
Patient characteristics of two treatment groups
jkos-53-544-i001

Values are presented as number or mean ± SD (range).

*Mann-Whitney test; †Fisher's exact test.

Table 2
Preoperative clinical status of the two treatment groups
jkos-53-544-i002

Values are presented as mean ± SD (range) or number (%).

IOP = intraocular pressure; BCVA = best corrected visual acuity; MD = mean deviation; LPI = laser peripheral iridotomy; VCDR = vertical cup to disc ratio.

*Mann-Whitney test; †Fisher's exact test.

Table 3
Intraocular pressure at various time points of follow-up for the two groups
jkos-53-544-i003

Values are presented as mean ± SD (n).

PE = phacoemulsification; n = number of eyes; IOP = intraocular pressure; PETL = phacotrabeculectomy.

*Postoperative IOP significantly lower than baseline IOP (p < 0.05, Wilcoxon signed rank test); †Mann-Whitney test.

Table 4
Change in the number of anti-glaucoma medication at various time points of follow-up for the two groups
jkos-53-544-i004

Values are presented as mean ± SD (n).

PE = phacoemulsification; n = number of eyes; PETL = phacotrabeculectomy.

*Significant reduction in number of anti-glaucoma medications between baseline and each follow-up visit; †Mann-Whitney test.

Table 5
Intraoperative and postoperative complications
jkos-53-544-i005

IOP = intraocular pressure.

*Fisher's exact test.

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