Comparison of Postoperative Refractive Outcomes after Phacotrabeculectomy and Phacoemulsification Subsequent to Trabeculectomy

Dong Eun Lee; Jung Lim Kim

doi:10.3341/jkos.2017.58.12.1349

Journal List > J Korean Ophthalmol Soc > v.58(12) > 1010682

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Lee and Kim: Comparison of Postoperative Refractive Outcomes after Phacotrabeculectomy and Phacoemulsification Subsequent to Trabeculectomy

Original Article

Journal of the Korean Ophthalmological Society 2017; 58(12): 1349-1355.

Published online: 14 December 2017

DOI: https://doi.org/10.3341/jkos.2017.58.12.1349

Comparison of Postoperative Refractive Outcomes after Phacotrabeculectomy and Phacoemulsification Subsequent to Trabeculectomy

Dong Eun Lee, MD^1,², Jung Lim Kim, MD, PhD^1,²

¹Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.

²T2B Infrastructure Center for Ocular Disease, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.

Address reprint requests to: Jung Lim Kim, MD, PhD. Department of Ophthalmology, Inje University Busan Paik Hospital, #75 Bokji-ro, Busanjin-gu, Busan 47392, Korea. Tel: 82-51-890-6016, Fax: 82-51-890-6329, pcheck@hanmail.net

Received 18 May 2017 Revised 29 September 2017 Accepted 4 December 2017

The Korean Ophthalmological Society

(open-access):

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 refractive outcomes in patients following either combined or sequential trabeculectomy and phacoemulsification.

Methods

Evaluation of the medical records of patients who underwent one of three treatment combinations on their eyes including combined phaco-trabeculectomy (47 eyes), a sequential phacoemulsification procedure, at least 3 months following trabeculectomy (33 eyes), and phacoemulsification alone (48 eyes).

Results

There were no significant differences among the three groups in characteristics such as age, sex, axial length, the postoperative spherical equivalent (SE) and refractive prediction error (RPE) at 1 week and 2 months post procedure. Significant differences existed between the three groups in terms of preoperative intraocular pressure, predicted SE, and the mean absolute error (MAE) at 1 week and 2 months post procedure. The proportions of cases with a RPE > 1.0 diopter (D) or <−1.0 D were significantly different between the three groups.

Conclusions

There were significant differences between the three groups in terms of the MAE at 1 week and 2 months after surgery. With respect to the predicted SE, phacotrabeculectomy seems to be less accurate than the phacoemulsification alone. Therefore, careful consideration should be given to the selection of the intraocular lens power.

Keywords: Cataract surgery, Glaucoma, Phacotrabeculectomy, Refraction, Trabeculectomy

Figures and Tables

Figure 1

Distribution of mean absolute error. (A) Box plots showing the distribution of mean absolute error at 1 week (y-axis) in patients in the combined group, the sequential group, and in the control group (x-axis). The box plots show the median, interquartile range, 95 percentile, outliers, and extreme values. (B) Box plots showing the distribution of mean absolute error at 2 months (y-axis) in patients in the combined group, the sequential group, and in the control group (x-axis). The box plots show the median, interquartile range, 95 percentile, outliers, and extreme values.

Table 1

Patient clinical characteristics

Values are presented as mean ± SD or n (%) unless otherwise indicated.

(a) = Combined group; (b) = Sequential group; (c) = Control group; POAG = primary open angle glaucoma; PACG = primary angle closure glaucoma; NVG = neovascular glaucoma; IOP = intraocular pressure.

^*By analysis of variance (ANOVA) test; ^†By χ² test; ^‡The mean preoperative intraocular pressure of the combined group was significantly higher than that of the control group and the sequential group; ^§The mean intraocular pressure of the combined group at 1 week after surgery was significantly higher than that of the control group; ^ΠThe mean difference of intraocular pressure between postoperative 1 week and pre-operation of control group and the sequential group was significantly higher than that of the combined group; ^#The mean difference of intraocular pressure between postoperative 2 months and pre-operation of control group and the sequential group was significantly higher than that of the combined group.

Table 2

Refractive outcomes of patients

Values are presented as mean ± SD or n (%) unless otherwise indicated.

(a) = Combined group; (b) = Sequential group; (c) = Control group; SE = spherical equivalent; RPE = refractive prediction error; MAE = mean absolute error; D = diopter.

^*By analysis of variance (ANOVA) test; ^†By χ² test; ^‡The predicted spherical equivalent of the combined group was significantly higher than that of the control group; ^§The mean absolute error of the combined group and sequential group at 1 week after surgery was significantly higher than that of the control group; ^ΠThe mean absolute error of the combined group at 2 months after surgery was significantly higher than that of the control group; ^#A χ² test was not performed for statistical reason, because the column with an expected frequency of less than 5 was greater than 20% of the total column.

Table 3

Prediction errors in the groups

Values are presented as n (%)

(a) = Combined group; (b) = Sequential group; (c) = Control group; D = diopter.

Notes

This study was presented as a poster at the 116th Annual Meeting of the Korean Ophthalmological Society 2016.

This study was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant #: HI15C1142).

^{Conflicts of Interest} The authors have no conflicts to disclose.

References

1. Chen PP, Weaver YK, Budenz DL, et al. Trabeculectomy function after cataract extraction. Ophthalmology. 1998; 105:1928–1935.

2. Caprioli J, Park HJ, Kwon YH, Weitzman M. Temporal corneal phacoemulsification in filtered glaucoma patients. Trans Am Ophthalmol Soc. 1997; 95:153–167. discussion 167-70.

3. Dickens MA, Cashwell LF. Long-term effect of cataract extraction on the function of an established filtering bleb. Ophthalmic Surg Lasers. 1996; 27:9–14.

4. Shin DH, Iskander NG, Ahee JA, et al. Long-term filtration and visual field outcomes after primary glaucoma triple procedure with and without mitomycin-C. Ophthalmology. 2002; 109:1607–1611.

5. Husain R, Li W, Gazzard G, et al. Longitudinal changes in anterior chamber depth and axial length in Asian subjects after trabeculectomy surgery. Br J Ophthalmol. 2013; 97:852–856.

6. Cashwell LF, Martin CA. Axial length decrease accompanying successful glaucoma filtration surgery. Ophthalmology. 1999; 106:2307–2311.

7. Claridge K, Galbraith JK, Karmel V, Bates AK. The effect of trabeculectomy on refraction, keratometry and corneal topography. Eye (Lond). 1995; 9(Pt 3):292–298.

8. Kook MS, Kim HB, Lee SU. Short-term effect of mitomycin-C augmented trabeculectomy on axial length and corneal astigmatism. J Cataract Refract Surg. 2001; 27:518–523.

9. Zhang N, Tsai PL, Catoira-Boyle YP, et al. The effect of prior trabeculectomy on refractive outcomes of cataract surgery. Am J Ophthalmol. 2013; 155:858–863.

10. Rockwood EJ, Larive B, Hahn J. Outcomes of combined cataract extraction, lens implantation, and trabeculectomy surgeries. Am J Ophthalmol. 2000; 130:704–711.

11. Kim SA, Kang JH, Park JI, Lee KH. Difference between postoperative refraction and predictive refraction after cataract operation in patients with coexisting cataract and primary angle-closure glaucoma. J Korean Ophthalmol Soc. 2005; 46:1983–1988.

12. Kim JE, Park SW. The refractive change after cataract surgery in patients with acute primary angle closure. J Korean Ophthalmol Soc. 2009; 50:1669–1673.

13. Chan JC, Lai JS, Tham CC. Comparison of postoperative refractive outcome in phacotrabeculectomy and phacoemulsification with posterior chamber intraocular lens implantation. J Glaucoma. 2006; 15:26–29.

14. Ong C, Nongpiur M, Peter L, Perera SA. Combined approach to phacoemulsification and trabeculectomy results in less ideal refractive outcomes compared with the sequential approach. J Glaucoma. 2016; 25:e873–e878.

15. Vernon S, Zambarakji HJ, Potgieter F, et al. Topographic and keratometric astigmatism up to 1 year following small flap trabeculectomy (microtrabeculectomy). Br J Ophthalmol. 1999; 83:779–782.

16. Cunliffe IA, Dapling RB, West J, Longstaff S. A prospective study examining the changes in factors that affect visual acuity following trabeculectomy. Eye (Lond). 1992; 6(Pt 6):618–622.

TOOLS

Similar articles