COMPARISON OF EFFECTIVENESS OF DIFFERENT TYPES OF COMBINED CATARACT AND GLAUCOMA SURGERY IN PATIENTS WITH OPEN-ANGLE GLAUCOMA

Published 2024 - 28th ESCRS Winter Meeting

Reference: FP81 | Type: Submission | DOI: 10.82333/fgvb-ak14

Authors: Volodymyr Melnyk* ¹

¹Anterior segment surgical,Clinic Visiobud,Kyiv,Ukraine;Society of Ukrainian Ophthalmic Surgeons,Kyiv,Ukraine

Purpose

Age-related open-angle glaucoma is one of the leading reason of visual loss and blindness. It usually combines with cataract development. In cases of advanced glaucoma, or uncorrected IOP in combination with cataract it is necessary to do combined surgical procedure - cataract and glaucoma operation. In Ukraine MIGS devices are not available now. Cataract surgery combines with such types of glaucoma surgery - Trabeculectomy, Microperforations of trabecula, Implantation of Ex-Press valve.

Setting

We compared the effectiveness of different types of glaucoma surgery in combination with cataract removal. The main assessing criteria were – mean IOP, quantity of eyedrops in postoperative period, necessity of repeated glaucoma surgical treatment, early postoperative complications (hypotony, cilio-choroidal detachment, hyphema)

Methods

113 patients (196 eyes), who were done combined cataract and glaucoma surgery, were under our control during 6 years. Mean age is 71±2,2 years old. All patients were operated in one clinic by one surgeon. Patients according to the type of glaucoma operation were divided on three groups: 1) Microperforation of trabecular meshwork group (131 eyes); 2) Trabeculectomy group (42 eyes); 3) Ex-Press valve implantation group (23 eyes).

Results

Mean IOP during 6 years of control in the first group was 18,2±2,2mmHg, in the second group - 16,6±3,0mmHg, in the third group – 20,6±3,3mmHg. Through 3 months after surgical procedure IOP decreased on mean 28% in the first group, 39% in the second group and 35% in the third group.

Necessity of repeated glaucoma operation, caused by no-compensated IOP or glaucoma optic nerve atrophy development: first group – 16 eyes (12%), second group – 4 eyes (9%), third group – 9 eyes (39%).

Mean quantity of hypotonic eye drops in postoperative period: first group – 0,91±0,22; second group – 0,66±0,32; third group – 1,92±0,42.

Quantity of early postoperative complication caused by hypotony: first group – 21 cases (16%), second group – 14 cases (24%), third group – 2 cases (9%).

Conclusion

The strongest hypotensive effect with worst quantity postoperative glaucoma drops and necessity of repeated glaucoma operations we observed in trabeculectomy cases, but we also observed high risk of early hypotony and hypotonic complications. The least quantity of complications was in Ex-Press group, but in this group risk of repeated glaucoma surgery and quantity of hypotensive drops postoperatively were highest. Microperforation of trabecular meshwork type of glaucoma surgery in combination with cataract removal is the operation of choice in patients with open-angle glaucoma, witch gives good long-term hypotensive effect with low risk of necessity of repeated glaucoma surgery and early complication, caused by low IOP.