Combined cataract and trabeculectomy surgery for advanced glaucoma in East Africa; visual and intra-ocular pressure outcomes

Abstract

Aim To investigate visual and intra-ocular pressure (IOP) outcomes of combined cataract and glaucoma surgery at a high-volume centre in East Africa carried out over a 1-year period (2006). Methods A retrospective analysis of patient records. Results A total of 163 patients were identified. Mean age was 67 years (SD 11, range 21-86 years) and 113 (69%) were men. Presenting visual acuity in the operated eye was 6/60 or worse in 135/163 (93%) and was o3/60 in 76 of 163 (47%) patients. Mean presenting IOP was 28 mm Hg (SD 9, range 12-60). Pre-operative cup disc ratios were 0.8 or worse in 131 of 163 (85%) patients. Phacotrabeculectomy (PT) was carried out in 130 (80%) cases, small incision cataract surgery trabeculectomy (SICST) in 10 (6.1%) cases, and extra-capsular cataract extraction trabeculectomy (ECCET) in 23 (14.1%) cases. In all, 107 (66%) attended for follow-up (mean interval 104 days, range: 6-390 years, SD 88) and at follow-up 75 (70%) patients had improved visual acuity pre-operatively. Pre-operative cup disc ratio of 0.9 or greater predicted failure to improve VA at follow-up (OR 4.0 95% confidence interval (CI) 1.30-12.1). Fifty-nine (62% (95%CI 52-71%)) patients had follow-up IOPs of 6-15 mm Hg and 82 (85% (95% CI 78-92%)) had follow-up IOPs of 6-20 mm Hg. Conclusion Combined surgery produces visual benefit for most patients with similar pressure control to pure trabeculectomy and is therefore a useful option in practises where follow-up may be doubtful.

Surgical outcome of safe surgery system trabeculectomy combined with cataract extraction

“…A success rate of 58% (IOPr15 mm Hg at 6 months) was reported by a retrospective study on 5-flurouracil-augmented combined surgery from East Africa. 4 A retrospective study analyzed 56 eyes that underwent safe surgery trabeculectomy and reported a success rate of 90.9 and 61.4% for IOPr18 and r14 mm Hg, respectively, beyond 12 months follow-up. 15 Another prospective study of safe surgery system trabeculectomy on 39 eyes showed that 74% had an IOPr15 mm Hg for 490% of their follow-up period of 3 years, without any antiglaucoma medications.…”

“…Trabeculectomy is thus performed as a primary procedure with cataract extraction and implantation of an intraocular lens (IOL). 3,4 Combined surgery has an advantage of controlling IOP without requiring the use of lifelong anti-glaucoma medication.…”

Calpain: a molecule to induce AIF-mediated necroptosis in RGC-5 following elevated hydrostatic pressure

“…HIOP is one of the main features and risk of visual impairment with ganglion cell death in glaucoma [33-35]. Some research demonstrated that acute increase or continuous arise of intra-ocular pressure (IOP) could lead to visual injury or cell death in retinal ganglion cells, pigment epithelial cells and finally resulting in vision lost.…”

Glaucoma Surgery Outcome in Rwanda

“…As vision rarely improves following simple trabeculectomy, offering systematically combined cataract and glaucoma surgery might be a useful option in motivating the patient to accept glaucoma surgery and to come back for regular eye check. 27 Whether combined cataract-glaucoma operation is as effective in lowering the IOP as a simple glaucoma intervention remains debated. 17 The Tube versus Trabeculectomy (TVT) study demonstrated a lower surgical failure requiring less reoperation in the Glaucoma Device Implant (GDI) group compared with the trabeculectomy group during 5 years of follow-up (29.8% failure rate in the GDI group vs. 46.9% in the trabeculectomy group; P = 0.002).…”