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Phaco ExPRESS versus phaco trabeculectomy in the treatment of OAG in cataract patients

Poster Details

First Author: M.Yilmazli TURKEY

Co Author(s):    A. Ustuner   A. Asici                 

Abstract Details

Purpose:

To compare the efficacy, safety and see the results and complications of Phacoemulsification with Trabeculectomy (P-Trab) versus Phacoemulsifacation with Ex-Press implantation surgery (P-Ex-Press) in patients with open angle glaucoma(OAG) that could not be controlled with maximal-tolerated anti glaucoma medications(or had drug allergy). The trabeculectomy is the gold standard procedure used in the treatment of glaucoma, although its complication profile is quite broad. Ex-Press device was introduced as an alternative to trabeculectomy.

Setting:

Patients from the Glaucoma Department of the �Ä�°stanbul Eye Hospital at �Ä�°stanbul, Turkey were included for this study.

Methods:

A total of 41-eyes diagnosed OAG and cataract underwent P-Ex-Press or P-Trab surgery.20 eyes were treated with P-Ex-Press and 21-eyes were treated with P-Trab(p>0.05).Mean age of the patients was 69-in both groups(p>0.05).22 female and 19 male patients were included(p>0.05).Both procedures involved the creation of a scleral flap.Than phacoemultification was performed.After an incision made with a needle,the Ex-Press device was implanted .In the second group,a sclerostomy and peripheral iridectomy were done.Cases were followed for 12 months.The main outcome measures were:mean intraocular pressure(IOP), IOP reduction,the reduction in glaucoma medications,the change of visual acuity and the incidence of postoperative complications.

Results:

IOP in the-P-ExPress group went from-34,6-to-15,0(decreased by 43%).In the-P-Trab group,it went from-33,2-to-14,5(decreased by 43,7%)(p<0.05).The average number of anti glaucoma medications in the-P-Ex-Press group went from 2.5-to-0.6;in theP-Trab group it went from-2.7-to-0.9 a year after surgery(p>0.05).Visual Acuity(VA)in the P-Ex-Press group improved from-0.25-to-0.54.VA in the P-Trab group improved from 0,24-to-0.51(p> 0.05).The most frequent complication were shallow anterior chamber (1and 4-cases in-P-Express versus P-Trab)and 1-hyphema in P-Trab group.In the P-Ex-PRESS group there was 1-case of bleb needling and 1-case of bleb revision.In the P-Trab group,2-eyes required bleb revision,1-eye required re-suturing,and 1-eye required repeat surgery for uncontrolled IOP with maximal-tolerated anti glaucoma medication.

Conclusions:

Both groups demonstrated significant IOPdecreases from baseline and had significant decreases in the mean number of IOP-lowering medications.Visual acuity at 12 months was improved in the majority of patients in both groups.The P-Ex-Press had a lower rate of postoperative complication and postoperative interventions required. Use of the Ex-Press device led to faster visual recovery because of less tissue damage.Ex-Press implantation is associated with higher surgical cost due to the cost of the device itself. The P-Press is one of the alternatives to P-Trab,equals in its efectiveness and is noted for less tissue traumatization and lower complications.

Financial Disclosure:

NONE

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