Combined Approach to Phacoemulsification and Trabeculectomy Results in Less Ideal Refractive Outcomes Compared With the Sequential Approach

Abstract

Purpose: To compare the refractive outcomes of combined versus sequential trabeculectomy and then phacoemulsification. Methods: We compared eyes that underwent uncomplicated combined phacotrabeculectomy (combined group, 87 eyes), phacoemulsification at least 3 months after trabeculectomy (sequential group, 56 eyes), and phacoemulsification only (control group, 78 eyes) between January 1, 2006 and January 1, 2014. The main outcome measure was refractive prediction error (RPE)—defined as postoperative subjective spherical equivalent refraction minus predicted spherical equivalent refraction. Results: The study population was predominantly Chinese and the mean age at their cataract surgery was 67.2±9.59 years. Compared with controls, RPE (−0.40±0.70 vs. −0.01±0.50, P<0.001) and mean absolute error (0.62±0.50 vs. 0.39±0.31, P=0.003) were greater for the combined group but not for the sequential group. Proportionately fewer patients in the combined group achieved final subjective refraction within ±0.5D (27.6% vs. 46.2%, P=0.01) compared with controls. Within the sequential group, there were no differences in RPE when the fellow eye axial length was used to predict refractive outcome (P=0.17) or between the group with precataract surgery IOPs of ≤11 mm Hg (−0.28±0.82) and the group with >11 mm Hg (−0.28±0.53, P=0.99). For the sequential group, the use of contact A scan yielded less RPE compared with IOLMaster (P=0.01). Conclusions: Combined approach to trabeculectomy and phacoemulsification resulted in greater myopic RPEs that were expectedly greater than those found in the phacoemulsification group.

Long-Term Refractive Outcomes After Combined Phacoemulsification and Trabeculectomy in Glaucoma Patients

“…It means that phacotrabeculectomy was effective not only for IOP control but also for stable refractive outcomes. Previous studies reported that myopic shift occurs after phacotrabeculectomy compared to phacoemulsi cation alone [11,[23][24][25]. A decreased ACD after trabeculectomy causes a myopic shift, and a decreased AL after trabeculectomy causes a hyperopic shift, conversely.…”

“…Most of the studies that focused the refractive outcomes of phacotrabeculectomy analyzed only shortterm refractive outcomes less than 6 months [11,18,[22][23][24][25], and one study reported by Chung et al [12] had a limitation that the follow-up period of the control group was average of 4.81 months. Therefore, the present study is clinically signi cant because we analyzed long-term refractive outcomes of phacotrabeculectomy up to 24 months postoperatively.…”

“…There is increasing interest in reducing refractive errors after phacotrabeculectomy because trabeculectomy can affect refractive outcomes after phacoemulsi cation. Recently, several studies focusing on refractive outcomes after phacotrabeculectomy have been published [11,18,[22][23][24][25].…”

Kombinierte Eingriffe bei Katarakt und Glaukom

“…So erreichten hier knapp 46,2 % der Augen mindestens 3 Monate nach dem Eingriff ein postoperatives sphärisches Äquivalent im Bereich von ±0,5 dpt. im Vergleich zu lediglich 27,6 % bei den kombinierten Eingriffen [15].…”

Intraocular Pressure, Axial Length, and Refractive Changes after Phacoemulsification and Trabeculectomy for Open-Angle Glaucoma

“…One study compared the eyes that underwent phacoemulsification at least 3 months after trabeculectomy with the eyes that did not undergo glaucoma surgery and reported that the change in IOP is negatively correlated with refractive surprise; a correlation between lower postoperative IOP or greater IOP reduction and the amount of axial length reduction was expected [14]. In addition, a recent study has revealed that refractive outcome is inferior in combined versus subsequent trabeculectomy [15]. On the other hand, a study comparing combined trabectome-cataract surgery with cataract-alone surgery did not find any differences in refractive and visual outcomes and a retrospective analysis showed favourable refractive outcomes in patients undergoing simultaneous cataract extraction with trabeculectomy or glaucoma drainage device surgery [16, 17].…”