Ophthalmology Department, Health Sciences University Turkey, Haydarpaşa Numune Research and Training Hospital, Istanbul, Turkey.
Ophthalmic Res. 2023;66(1):672-680. doi: 10.1159/000529642. Epub 2023 Feb 23.
Conflicting results have been reported on phacoemulsification in the filtered eyes with open-angle glaucoma. In this study, we aim to compare the effect of phacoemulsification after trabeculectomy between pseudoexfoliation glaucoma (XFG) and primary open-angle glaucoma (POAG).
Consecutive patients with XFG and POAG who underwent uneventful phacoemulsification after trabeculectomy with 5-fluorouracil (TRAB-PHACO group) were reviewed retrospectively and matched to patients who underwent trabeculectomy only (TRAB group). Comparisons were performed for IOP, medication numbers, and success rates. Surgical failure was defined as IOP >21 mm Hg or IOP ≤21 mm Hg with additional medication or glaucoma surgery. Survival analysis was investigated by Kaplan-Meier test and the factors influencing final success by multivariate logistic regression analysis.
The records of 204 patients were reviewed. In XFG, when compared with the baseline, increase in IOP became statistically significant at the at 24-month visit in the TRAB-PHACO group (p = 0.002), at the 6-month visit (p = 0.001) in the TRAB group and remained so throughout the follow-up. In the TRAB-PHACO group, increase of glaucoma medications was statistically significant only at the last visit (p = 0.001) in XFG, at the 6-month visit (p = 0.02) in POAG and remained so throughout the follow-up. Two glaucoma types did not differ statistically from one another in terms of survival analysis. In the TRAB group, the additional glaucoma surgery was more common in XFG compared to POAG (p = 0.02). The trabeculectomy failure after phacoemulsification was related with an IOP spike >25 mm Hg at postoperative first 24h (p = 0.04).
In the filtered eyes with XFG, uneventful phacoemulsification may delay time-related worsening in IOP control and may decrease the additional glaucoma surgery need.
在开角型青光眼滤过过的眼中，超声乳化术的结果存在争议。本研究旨在比较原发性开角型青光眼（POAG）和假性剥脱综合征（XFG）患者小梁切除术后行超声乳化术的效果。
回顾性分析了 204 例连续接受无并发症超声乳化术联合 5-氟尿嘧啶（TRAB-PHACO 组）治疗的 XFG 和 POAG 患者的临床资料，并与仅接受小梁切除术（TRAB 组）的患者进行了匹配。比较两组患者的眼压（IOP）、药物使用数量和成功率。手术失败定义为 IOP>21mmHg 或 IOP≤21mmHg 需加用药物或行青光眼手术。采用 Kaplan-Meier 检验进行生存分析，采用多因素逻辑回归分析影响最终成功率的因素。
在 XFG 中，与基线相比，TRAB-PHACO 组患者在术后 24 个月（p=0.002）、TRAB 组患者在术后 6 个月（p=0.001）时 IOP 升高有统计学意义，且在整个随访过程中一直如此。在 TRAB-PHACO 组中，XFG 患者仅在最后一次随访时（p=0.001）、POAG 患者在术后 6 个月时（p=0.02）需要增加青光眼药物治疗，且在整个随访过程中一直如此。两种青光眼类型在生存分析方面无统计学差异。在 TRAB 组中，XFG 患者比 POAG 患者更需要行额外的青光眼手术（p=0.02）。超声乳化术后小梁切除术失败与术后 24 小时内 IOP 升高>25mmHg 有关（p=0.04）。
在 XFG 滤过过的眼中，超声乳化术可能会延迟眼压控制的时间相关性恶化，并可能减少额外的青光眼手术需求。
