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Pseudoexfoliation glaucomatous eyes do better with combined surgery
PSEUDOEXFOLIATION syndrome patients represent a special challenge to cataract and glaucoma specialists alike. A longterm Italian study confirms the safety and efficacy of combined sclerectomy and cataract surgery in these patients, Domenico D'Eliseo MD told the XXI Congress of the ESCRS. The study involved 174 eyes of 150 patients with cataract and/or ocular hypertension. It compared the IOP-lowering effect of deep sclerectomy with that of combined deep sclerectomy and phacoemulsification in patients with or without pseudoexfoliation syndrome. The patients were divided into four treatment groups. The first group included 30 eyes affected by pseudoexfoliation that underwent deep-sclerectomy (PEX-DS). The second group (48 eyes) did not have pseudoexfoliation but did undergo deep-sclerectomy (NO PEX-DS). The third group (51 eyes) comprised eyes affected by pseudoexfoliation that underwent phacoemulsification and deep sclerectomy (PEX-PDS). The fourth group (45 eyes) did not have pseudoexfoliation but did undergo phacoemulsification and deep sclerectomy (NO PEX-PDS). The study defined success as reaching target IOP (less than 18 mmHg- 21 mmHg) without additional glaucoma medication. Qualified success was defined as reaching target IOP with or without additional treatment. Mean follow-up was 23.9 months (12 to 36 months).All four groups experienced IOP reductions immediately following surgery. The first group had a median IOP of 15 mmHg and the second group had 16 mmHg. The third group reached a mean 15 mmHg and the fourth group reached 13.5 mmHg.
Domenico D'Eliseo MD
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The best IOP control was obtained in the two groups that underwent combined surgery, regardless of the presence of pseudoexfoliation. Three months after surgery, 6% and 7% of patients of the third and fourth groups respectively needed medical therapy, compared with 30% and 19% of the first and second groups respectively. Two years after surgery the differences between the groups were even greater, with 90% and 75% of eyes belonging to the first and second group still receiving additional treatment. Only 18% and 7% of the third and fourth groups respectively needed additional medication. 
At the two-year mark, 90% of eyes with pseudoexfoliation operated with deep-sclerectomy alone required additional medication, versus only 18% of eyes operated with phacoemulsification combined with deep-sclerectomy. The investigators concluded that pseudoexfoliation syndrome does not affect the results of deep-sclerectomy, either combined with phacoemulsification or alone. Their results also suggest that in eyes affected by pseudoexfoliation, combined surgery achieves better results: longer lasting effects and better controlled IOP. "Our data seem to show that, in eyes affected by pseudoexfoliation, combined surgery achieve a better result and a longer untreated IOP regulation. Among cases submitted to deep sclerectomy alone, the rate of eyes which still need medications is significantly higher than that of the group that underwent combined surgery."