ESCRS Homepage

January 2003
IN THIS ISSUE

Long-term SLT results promise ‘valuable’ primary treatment
Retinal transplantation trials for RP look set to begin
EU guidelines give optimal correction licence to fly
Treatment for retinal dystrophies near fruition
Blindness cases climb in 60 to 80 years age bracket
WHO initiative targets childhood blindness
Digitised retinopathy screening improves efficiency
New hypotheses emerge on causes of wet AMD
Cataract surgery on the couch: What the future holds
Dark adaptation offers clue to earlier AMD diagnosis
Smoking may cause blindness in 20% of over 50-year-olds, say studies
New 3-D monitor brings surgery into digital world
CrystaLens new focus for spectacle-free vision
Long-term ICL data promising but cataracts still concern
Tattered Serbian health
system draws on ECOSG in fight against blindness
Atonic pupil a rare
cosmetic problem in cataract patients
Harvard study confirms phaco safety in patients with blebs
Cryoanalgesia affords drug-free anaesthesia for phaco
Paediatric myopia still hangs in ‘nature-nurture’ balance
Orbscan II alternative to infrared pupillometry
Femtosecond laser microkeratome offers advantages of ‘precisely centred’ thin flaps
Anger as surgeons are ‘used as pawns’ in Nidek US legal action
Popular SKBM microkeratomes are
recalled as product line is terminated
Simulating womb greatly reduces ROP rate
Molecular biology insights bring new treatments to fore
FEATURES
From The Editor
Reflections on Refractive Surgery
In Your Good Books
An Eye On Travel
Bio-ophthalmology
Regulatory Matters



Harvard study confirms phaco safety in patients with blebs

By Cheryl Guttman

PHILADELPHIA — Modern cataract surgery can be performed safely and effectively in glaucoma patients with functioning blebs, reported Harvard University researchers at the annual ASCRS Symposium on Cataract, IOL and Refractive Surgery
Investigators at Harvard University’s Massachusetts Eye and Ear Infirmary studied outcomes in patients with existing, well-functioning blebs who underwent phacoemulsification.

That review found that modern cataract surgery, whether performed through a temporal clear corneal incision or temporally via a scleral tunnel, restores visual acuity without jeopardising bleb function.
However, the average patient experienced a modest 2.0 mm Hg increase in intraocular pressure (IOP), Bradford J. Shingleton MD reported.
“After glaucoma surgery, the risk of cataract formation increases by 78%. These results highlight that when phacoemulsification is performed in eyes with a well-functioning filter, we can expect significantly improved best-corrected vision, just as we would after any routine phacoemulsification procedure.

“However, it is important for surgeons to be aware of the potential for an IOP increase and be prepared to deal with that event in eyes with compromised optic nerves and visual field loss,” Dr Shingleton said.
The series included 58 eyes of 48 patients, all operated on by Dr Shingleton and all with a minimum follow-up of one year.
The population was predominantly Caucasian and primary open-angle glaucoma was the most common diagnosis (81%). The one-year visit data showed the surgery resulted in a highly statistically significant improvement in logMAR equivalent BSCVA from 0.8 to 0.4.

The one-year data also indicated no significant change in glaucoma medication requirement. Preoperatively, the average patient was receiving 0.6 medications and average number of postoperative medications used per patient was 0.5.
However, IOP increased from 11.8 mm Hg preoperatively to 13.7 mm Hg at one year, and the mean change of 1.9 mm Hg was statistically significant.
“The effect of phacoemulsification on IOP in eyes with functioning filters is consistent with other reports in the literature, but is in contrast with the situations of normal eyes, glaucoma suspects and even glaucomatous eyes without a pre-existing filter where phacoemulsification is associated with a significant reduction in IOP” Dr Shingleton said.
The 58 cases included 32 eyes operated on using a temporal clear cornea approach and 26 had surgery with a temporal scleral tunnel incision.

No statistically significant differences were found in postoperative visual outcomes, IOP or glaucoma medication requirements between eyes operated on through a clear corneal versus scleral tunnel approach, Dr Shingleton reported.
In about half of the eyes, filtering surgery was performed with adjunctive mitomycin-C. There was no statistically significant difference in any of the study endpoints between those eyes and their counterparts which underwent glaucoma surgery without mitomycin-C enhancement.

The average time between filtering surgery and phacoemulsification was seven years and bleb function was good in all of the eyes at the time of phacoemulsification.
However, there was a wide range in the interval between procedures. An appreciable proportion underwent cataract surgery within six to 12 months after the glaucoma procedure.

Time since glaucoma surgery also was found to have no effect on patient outcomes after phacoemulsification, Dr Shingleton noted.
No intraoperative complications were encountered. Postoperatively, the only complication within the 58-eye series was a requirement for surgical bleb revision for elevated IOP in one eye.
“Complications are minimal when performing phacoemulsification in eyes with a well-functioning bleb but this particular patient’s case demonstrates clearly that there is a risk of failure,” Dr Shingleton said.



Top