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Viscocanalostomy and phacoviscocanalostomy with adjuvant Nd:YAG goniopuncture

Poster Details

First Author: A.Shirodkar UK

Co Author(s):    D. Ahnood   D. Mathews           

Abstract Details



Purpose:

To compare the outcomes of Viscocanalostomy (VC) to Phacoviscocanalostomy (PV) when augmented with Nd:YAG Goniopuncture (GP) enhance intraocular pressure control (IOP) in eyes with medically uncontrolled glaucoma.

Setting:

Ophthalmology department, Abergele Hospital, North Wales, UK

Methods:

Prospective database and notes review of 598 VC and PV operations performed at Abergele hospital between 2009 and 2011. 8 eyes with greater than one GP performed were excluded. Data collected included: demographic details of the patients, IOP at fixed follow up periods and the number of topical anti-glaucomatous medications required and when started. Success of the procedure was defined as: total success (≥20% reduction in IOP from GP without topical medication), qualified success (≥20% reduction with topical medication) and failure (requiring further surgery). Statistical analysis was performed, p<0.05 was deemed statistically significant.

Results:

GP was performed in 20.21% eyes after a mean 14.09months. Surgery type was associated with GP, significantly sooner in PV eyes p=0.0319. Mean age of patients was 71.70 years, with no difference between surgery type p=0.3504. 56% were right eyes and 71.71% had a diagnosis of primary open angle glaucoma. 11 eyes were further excluded with less than 6 months follow up. Average follow up of included eyes was a mean 19.94months. Overall there was a mean 22% reduction in IOP from pre-GP measurements(95% CI 17.8% to 26.3%). 59% achieved a ≥20% reduction in IOP at final follow up compared to pre-GP measurements. 66% of eyes had an IOP of ≤18mmHG by final follow up. 58(59%)eyes achieved a qualified success, with no difference between surgery type(x2 p=0.1744). Mean drops required after GP was 0.91±0.77, with no association with surgery type p=0.2772. 19(19.19%)eyes achieved total success by final follow up, with a possible association with VC compared to PV(x2 p=0.0924). Compared to PV, eyes that underwent VC had a higher: highest IOP prior to listing for surgery(p=0.05); mean IOP at surgery listing(p=0.046). No significant difference in IOP was observed at set time points post-GP thereafter. No complications were experienced.

Conclusions:

Although patients that underwent PV required GP sooner, no other significant differences with IOP or success outcomes were found between the two surgery types. Our results add data supporting GP as an effective, safe, adjunctive treatment when managing glaucoma with VC or PV. FINANCIAL INTEREST: NONE

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