Treatment Outcome of Triple Procedure in Open-Angle Glaucoma and Angle-Closure Glaucoma

Kye Yoon Kwon; Hyung Won Bae; Sang Yeop Lee; Sang Jin Seo; Yun Ha Lee; Sa Min Hong; Gong Je Seong; Chan Yun Kim

doi:10.3341/jkos.2015.56.7.1075

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Kwon, Bae, Lee, Seo, Lee, Hong, Seong, and Kim: Treatment Outcome of Triple Procedure in Open-Angle Glaucoma and Angle-Closure Glaucoma

Original Article

J Korean Ophthalmol Soc 2015;56(7):1075-1080.

Published online: 27 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.7.1075

Treatment Outcome of Triple Procedure in Open-Angle Glaucoma and Angle-Closure Glaucoma

Kye Yoon Kwon, M.D, Hyung Won Bae, M.D, Sang Yeop Lee, M.D, Sang Jin Seo, M.D, Yun Ha Lee, M.D, Sa Min Hong, M.D, PhD, Gong Je Seong, M.D, PhD, Chan Yun Kim, 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.

Received 21 November 201420 January 2015 Accepted 26 May 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.

Keywords: Angle-closure glaucoma, Open-angle glaucoma, Triple procedure

References

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Figure 1.

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.

Table 1.

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.

Table 2.

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.

Table 3.

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.

Table 4.

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;

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