Intraocular pressure 3 to 4 hours and 20 hours after cataract surgery with and without ab interno trabeculectomy

Weiner, Yotam; Severson, Melissa L.; Weiner, Asher

doi:10.1016/j.jcrs.2015.10.048

Cited by 15 publications

(11 citation statements)

References 32 publications

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“…[ 20 ] In contrast, trabectome-mediated ab interno trabeculectomy in our study achieved a profound IOP reduction already on day 1 and week 1 without any of the dangerous IOP elevations that can be seen in eyes with glaucoma undergoing cataract surgery. [ 21 ] Thus, unlike studies that have shown synergistic IOP reduction when combining a microbypass stent implantation with cataract removal,[ 8 , 22 , 23 ] the results here suggest that adding phacoemulsification to trabectome surgery in hopes of further reducing pressure may not provide these additional benefits. It may be more cost effective and safer to only focus on TM ablation in patients without a visually significant cataract.…”

Section: Discussioncontrasting

confidence: 63%

Coarsened Exact Matching of Phaco-Trabectome to Trabectome in Phakic Patients: Lack of Additional Pressure Reduction from Phacoemulsification

et al. 2016

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PurposeTo compare intraocular pressure (IOP) after trabectome-mediated ab interno trabeculectomy surgery in phakic patients (T) and trabectome with same session phacoemulsification (PT) using Coarsened Exact Matching. Although phacoemulsification is associated with IOP reduction when performed on its own, it is not known how much it contributes in PT.MethodsSubjects were divided into phakic T and PT. Exclusion criteria were follow-up for <12 months and additional glaucoma surgery. Demographics were compared by the Mann-Whitney U test and chi-squared test for continuous and categorical variables, respectively. Multiple imputation was utilized to avoid eliminating data with missing values. Groups were then matched using Coarsened Exact Matching based on age, race, type of glaucoma, baseline IOP, and number of preoperative glaucoma medications. Univariate linear regression was used to examine IOP reduction after surgery; those variables that were statistically significant were included in the final multivariate regression model.ResultsA total of 753 cases were included (T: 255, PT: 498). When all variables except for age were kept constant, there was an additional IOP reduction of 0.05±0.01 mmHg conferred for every yearly increment in age. Every 1 mmHg increase in baseline IOP correlated to an additional IOP reduction of 0.80±0.02 mmHg. Phacoemulsification was not found to be a statistically significant contributor to IOP when comparing T and PT (p≥0.05). T had a 21% IOP reduction to 15.9±3.5 mmHg (p<0.01) while PT had an 18% reduction to 15.5±3.6 mmHg (p<0.01). Number of medications decreased (p<0.01) in both groups from 2.4±1.2 to 1.9±1.3 and from 2.3±1.1 to 1.7±1.3, respectively.ConclusionPhacoemulsification does not make a significant contribution to postoperative IOP or number of medications when combined with trabectome surgery in phakic patients.

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Section: Discussioncontrasting

confidence: 63%

Coarsened Exact Matching of Phaco-Trabectome to Trabectome in Phakic Patients: Lack of Additional Pressure Reduction from Phacoemulsification

et al. 2016

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“…IOP in BT with phacoemulsification was not significantly different from BT alone, reflecting our prior results that phacoemulsification does not add to the IOP lowering effect when combined with trabectome surgery [15]. Although phacoemulsification has been advocated as providing a trabeculoplasty-like, additional IOP reduction [41], glaucomatous trabecular meshwork is often unpredictable and can result in IOP spikes [42,43]. We observed this on day 1 in patients in B with phacoemulsification.…”

Section: Discussionsupporting

confidence: 68%

Coarsened Exact Matching of Trabectome Surgery Combined with Baerveldt to Baerveldt: Same Session Trabectome Negates Tube Fenestration

Esfandiari¹,

Hassanpour²,

Knowlton³

et al. 2018

Preprint

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Purpose: To evaluate the efficacy and survival rates of trabectome-mediated ab interno trabeculectomy combined with non-fenestrated Baerveldt glaucoma implants (BT) in comparison to Baerveldt glaucoma implant alone (B).Method: A total of 175 eyes undergoing primary glaucoma surgery (60 eyes BT and 115 B) were enrolled in this retrospective comparative case series. Participants were identified using the procedural terminology codes. Groups were then matched using Coarsened Exact Matching (51 eyes in each group). The primary outcome measure was surgical success, defined as 5 mmHg < IOP ≤ 21 mmHg, and IOP reduction ≥ 20% from baseline, and no reoperation for glaucoma. Secondary outcome measures were intraocular pressure, the number of glaucoma medications, and best corrected visual acuity (BCVA).Results: The cumulative probability of success at one year was 61% in BT, and 50% in B. IOP decreased significantly from 23.5±2.4 mmHg at baseline to 14.1±2.7 mmHg at the final follow up in BT (P= 0.001). The corresponding numbers for B were 23.2± 2.0 and 13.9± 1.6, respectively (P= 0.001). There was no significant difference in IOP at the final follow-up (P=0.56). The number of medications at baseline was 2.3±0.3 in both groups. However, BT needed significantly fewer drops at all postoperative time intervals and used 1.1±0.3 (BT) and 2.0±0.4 eye drops (B) at the final follow-up visit (P= 0.004). No dangerous hypotony or hypertension occurred in BT.Conclusion: Similar rates of success and IOP reduction were observed in BT and B. BT needed significantly fewer glaucoma medications. Tube fenestration was not necessary in BT resulting in less postoperative hypotony and hypertension.

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“…This effect may be the result of a trabeculoplasty-like effect [24, 25], brought on by a stress response [26] or at other times due to a resolved phacomorphic component [27]. On the other hand, it is not uncommon for glaucoma patients who already have a compromised trabecular meshwork to experience pressure spikes after cataract surgery [28, 29]; those can be prevented by combining trabecular ablation with cataract surgery [30]. Combining phacoemulsification with AIT has many advantages that include functional vision improvement, reduction of cost and efforts and good safety [11].…”

Section: Discussionmentioning

confidence: 99%

Stratification of phaco-trabectome surgery results using a glaucoma severity index in a retrospective analysis

et al. 2017

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BackgroundTo stratify the outcomes of phacoemulsification combined with trabectome surgery using a new glaucoma severity index.MethodsThis is a retrospective, observational cohort study that included open angle glaucoma patients with visually significant cataract that had phacoemulsification combined with trabectome surgery. Exclusion criteria were follow-up less than 12 months, any other surgeries or diagnosis of neovascular or active uveitic glaucoma. Patients were stratified into four groups according to the Glaucoma Index (GI) that incorporated preoperative intraocular pressure (IOP), number of medications and visual field status. The primary outcome measures were IOP reduction and the success rate at 12 months. We examined the relationship between GI group and IOP and medications at one year with a linear regression analysis and survival with log-rank testing.ResultsOf 1374 patients, a total of 498 cases with 12 month follow-up were included in the study after applying the exclusion criteria. At one year, IOP of GI groups 1 through 4 was reduced by 2.9 ± 4.4, 3.6 ± 5.0, 3.9 ± 5.3, and 9.2 ± 7.6 mmHg for. Individuals in the next higher GI group had a 1.69 ± 0.2 mmHg larger IOP decrease. The success rate was 98%, 93%, 96% and 88% at one year for GI groups 1 to 4 (p < 0.05).ConclusionsA substantial IOP reduction was seen in subjects with more advanced glaucoma suggesting that the trabecular meshwork is the primary impediment to outflow and its ablation benefits those eyes relatively more than in mild glaucoma. A larger IOP reduction can be expected in individuals with a higher GI group that indicates a clinically more challenging glaucoma.

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Intraocular pressure 3 to 4 hours and 20 hours after cataract surgery with and without ab interno trabeculectomy

Abstract: No author has a financial or proprietary interest in any material or method mentioned.

Cited by 15 publications

References 32 publications

Coarsened Exact Matching of Phaco-Trabectome to Trabectome in Phakic Patients: Lack of Additional Pressure Reduction from Phacoemulsification

Coarsened Exact Matching of Phaco-Trabectome to Trabectome in Phakic Patients: Lack of Additional Pressure Reduction from Phacoemulsification

Coarsened Exact Matching of Trabectome Surgery Combined with Baerveldt to Baerveldt: Same Session Trabectome Negates Tube Fenestration

Stratification of phaco-trabectome surgery results using a glaucoma severity index in a retrospective analysis

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