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First Author: A.Liaska GREECE
Co Author(s): D. Papakonstantinou P. Theodosiadis K. Chatzistefanou
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To compare the outcomes of phacoemulsification alone versus phacoemulsification-trabeculectomy in patients with cataract and advanced open angle glaucoma (Mean Deviation worse than -12 dB)with intraocular pressure controlled (consistently below 22 mmHg) on topical medications and to identify predictive factors of midterm postoperative course.
(1) Glaucoma Clinic, Department of Ophthalmology, General Hospital of Lamia, Lamia, GREECE (2)University of Athens, A Department of Ophthalmology, GENNIMATAS Hospital, Athens, Greece (3)University of Athens, B Department of Ophthalmology, ATTIKON Hospital, Athens, Greece
32 patients undergoing phacoemulsification alone versus 23 patients undergoing combined phacoemulsification-trabeculectomy were prospectively studied. Main outcome measures: postoperative reduction of intraocular pressure (IOP), visual acuity (VA) improvement, visual field mean deviation (MD) change, number of antiglaucoma medications needed up to 2 years postoperatively.
in the multivariate model assessment of predictive factors: (i)compared to phacoemulsification alone, phacotrabeculectomy allowed for an additional mean reduction of IOP by 3.4 mmHg and of the number of antiglaucoma medications by 2.1 postoperatively (ii)postoperative VA improvement correlated negatively to the presence of relative afferent pupillary defect(RAPD), (iii)the postoperative MD was positively related to preoperative MD and female gender and negatively to the cup-disc ratio and presence of RAPD.
Phacotrabeculectomy resulted in a more significant reduction of IOP and number of antiglaucoma medications postoperatively than phacoemulsification alone, whereas VA improvement was comparable in the two groups. Both VA and MD postoperative improvement were inversely related to the severity of glaucomatous damage of the optic nerve.