Abstract
Background
To evaluate and compare the results and complications after uneventful phaco-deep sclerectomy in one eye with intended phaco-deep sclerectomy converted to phaco-trabeculectomy in the fellow eye.
Methods
In this retrospective study, we analyzed thirty-two eyes of sixteen patients in which bilateral phaco-deep sclerectomy was planned but one eye was converted to phaco-trabeculectomy after perforation of the trabeculo-Descemet’s membrane. Visual acuity (VA), slit-lamp examinations, intraocular pressure (IOP), and the number of glaucoma medications were recorded preoperatively and postoperatively at 1 day, 1 week, and 1, 3, 6, 12, 18, and 24 months. The postoperative complications were recorded. Comparisons between the two groups were performed.
Results
The IOP was significantly lower in both groups at every postoperative visit. The postoperative IOP and VA levels did not differ significantly between the groups. However, at the last postoperative visit, eyes that underwent uneventful phaco-deep sclerectomy required fewer glaucoma medications than eyes converted to phaco-trabeculectomy (P = 0.04). At 24 months, the group that underwent uneventful phaco-deep sclerectomy had a higher complete success rate (P = 0.01). Immediate postoperative complications such as hyphema, a shallow anterior chamber, or a choroidal detachment occurred more frequently in eyes converted to phaco-trabeculectomy, although the difference did not reach significance.
Conclusions
There were no differences in VA or IOP control between uneventful phaco-deep sclerectomy and phaco-deep sclerectomy converted to phaco-trabeculectomy. However, fewer drugs were needed to successfully control IOP and the rate of complications was lower if phaco-deep sclerectomy was completed uneventfully.
Similar content being viewed by others
References
Gianoli F, Schnyder CC, Bovey E, Mermoud A (1999) Combined surgery for cataract and glaucoma: phacoemulsification and deep sclerectomy compared with phacoemulsification and trabeculectomy. J Cataract Refract Surg 2:340–34
McCartney DL, Memmen JE, Stark WJ, Quiqley HA, Maumenee AE, Gottsch JD, Bernitsky DA, Wong SK (1988) The efficacy and safety of combined trabeculectomy, cataract extraction, and intraocular lens implantation. Ophthalmology 95:754–763
Allan BD, Barrett GD (1993) Combined small incision phacoemulsification and trabeculectomy. J Cataract Refract Surg 19:97–102
Tanito M, Ohira A, Chihara E (2002) Factors leading to reduced intraocular pressure after combined trabeculotomy and cataract surgery. J Glaucoma 11:3–9
Swamynathan K, Capistrano AP, Cantor LB, WuDunn D (2004) Effect of temporal corneal phacoemulsification on intraocular pressure in eyes with prior trabeculectomy with an antimetabolite. Ophthalmology 111:674–678
Chen PP, Weaver YK, Budenz DL, Feuer WJ, Parrish RK 2nd (1998) Trabeculectomy function after cataract extraction. Ophthalmology 105:1928–1935
Rebolleda G, Muñoz-Negrete FJ (2002) Phacoemulsification in eyes with functioning filtering blebs. A prospective study. Ophthalmology 109:2248–2255
Wedrich A, Menapace R, Radax U, Papapanos P (1995) Long-term results of combined trabeculectomy and small incision cataract surgery. J Cataract Refract Surg 21:49–54
El Sayyad F, Helal M, El-Kholify H, Khalil M, El-Maghraby A (2000) Nonpenetrating deep sclerectomy versus trabeculectomy in bilateral primary open-angle glaucoma. Ophthalmology 107:1671–1674
Chiselita D (2001) Non-penetrating deep sclerectomy versus trabeculectomy in primary open-angle glaucoma surgery. Eye 15:197–201
Cillino S, Di Pace F, Casuccio A, Calvaruso L, Morreale D, Vadalà M, Lodato G (2004) Deep sclerectomy versus punch trabeculectomy with or without phacoemulsification: a randomized clinical trial. J Glaucoma 13:500–506
Shaarawy T, Karlen M, Schnyder C, Achache F, Sanchez E, Mermoud A (2001) Five-year results of deep sclerectomy with collagen implant. J Cataract Refract Surg 27:1770–1778
Dahan E, Drusedau MU (2000) Nonpenetrating filtration surgery for glaucoma: control by surgery only. J Cataract Refract Surg 26:695–701
Rebolleda G, Munoz-Negrete FJ (2004) Phacoemulsification-deep sclerectomy converted to phacotrabeculectomy. J Cataract Refract Surg 30:1597–1598
Sanchez E, Schnyder CC, Mermoud A (1997) Comparative results of deep sclerectomy transformed to trabeculectomy and classical trabeculectomy. Klin Monatsbl Augenheilkd 210:261–264
Rebolleda G, Munoz-Negrete FJ (2005) Comparison between phaco-deep sclerectomy converted into phaco-trabeculectomy and uneventful phaco-deep sclerectomy. Eur J Ophthalmol 15:343–346
Kobayashi H, Kobayashi K (2007) Randomized comparison of the intraocular pressure-lowering effect of phacoviscocanalostomy and phacotrabeculectomy. Ophthalmology 114:909–914
Ambresin A, Shaarawy T, Mermoud A (2002) Deep sclerectomy with collagen implant in one eye compared with trabeculectomy in the other eye of the same patient. J Glaucoma 11:214–220
Torres-Suarez E, Rebolleda G, Munoz-Negrete FJ, Cabarga C, Rivas L (2007) Influence of deep scleral flap size on intraocular pressure after deep sclerectomy. Eur J Ophthalmol 17:350–356
Park M, Hayashi K, Takahashi H, Tanito M, Chihara E (2006) Phaco-viscocanalostomy versus phaco-trabeculotomy: a middle-term study. J Glaucoma 15:456–461
Lüke C, Dietlein TS, Lüke M, Konen W, Krieglstein GK (2007) Phaco-trabeculotomy combined with deep sclerectomy, a new technique in combined cataract and glaucoma surgery: complication profile. Acta Ophthalmol Scand 85:143–148
Conflict of interest
None of the authors has any proprietary interest in any of the items mentioned in this study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Cabarga-Nozal, C., Arnalich-Montiel, F., Fernández-Buenaga, R. et al. Comparison between phaco-deep sclerectomy and phaco-deep sclerectomy reconverted into phaco-trabeculectomy: series of fellow eyes. Graefes Arch Clin Exp Ophthalmol 248, 703–708 (2010). https://doi.org/10.1007/s00417-009-1255-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00417-009-1255-7