Abstract
Purpose
To verify the advantages of trabeculotomy combined with phacoemulsification, intraocular lens implantation and sinusotomy (PTOS) in eyes with exfoliation glaucoma (XFG) and a coexisting cataract.
Patients and methods
Sixty-six eyes of 62 Japanese XFG patients that received either PTOS, phacotrabeculectomy (PTE) or MMC trabeculectomy (LEC) were followed for up to 36 months at Niigata University Medical and Dental Hospital. The outcomes of postoperative intraocular pressure (IOP) and visual acuity as well as complications were compared among the patients who underwent the three surgical procedures.
Results
The average preoperative IOP in the PTOS cases was 22.4 ± 5.13 mmHg, but decreased to 12.3 ± 2.33 mmHg at 12 months post-surgery and was maintained for up to 36 months. The preoperative IOPs, which were 21.9 ± 4.18 mmHg in the PTE group and 26.6 ± 7.57 mmHg in the LEC group, decreased to 13.3 ± 2.79 mmHg in the PTE group and 12.6 ± 6.00 mmHg in the LEC group at 12 months. There were no statistical differences among the three groups at any time point after 3 months. While the postoperative corrected visual acuities were similar between the PTOS and PTE groups, the average time in which the best postoperative visual acuity was reached was significantly shorter in the PTOS group (1.37 ± 1.74 months) than in the PTE group (4.92 ± 4.36 months).
Conclusions
PTOS can be recommended as an initial glaucoma surgery for XFG eyes with coexisting cataracts, because PTOS is not a filtering surgery, but can obtain similar IOP effects as PTE for XFG eyes.
Similar content being viewed by others
References
Ritch R. Exfoliation syndrome. In: Ritch R, Shields MB, Krupin T, editors. The glaucomas. 2nd ed. St. Louis: Mosby; 1996. p. 993–1022.
Ritch R, Schlotzer-Schrehardt U. Exfoliation syndrome. Surv Ophthalmol. 2001;45:265–315.
Ritch R, Schlotzer-Schrehardt U, Konstas AGP. Why is glaucoma associated with exfoliation syndrome? Prog Retin Eye Res. 2003;22:253–75.
Schlotzer-Schrehardt U, Naumann GOH. Ocular and systemic pseudoexfoliation syndrome. Am J Ophthalmol. 2006;141:921–37.
Sugino T. Exfoliative materials in the skin of the patients. Acta Soc Ophthalmol Jpn. 1990;94:856–62.
Streeten BW, Dark AJ, Wallace RN, Li ZY, Hoepner JA. Pseudoexfoliative fibrillopathy in the skin of patients with ocular pseudoexfoliation. Am J Ophthalmol. 1990;110:490–9.
Schlotzer-Schrehardt U, Koca MR, Naumann GOH, Volkholz H. Pseudoexfoliation syndrome. ocular manifestation of a systemic disorder? Arch Ophthalmol. 1992;110:1752–6.
Streeten BW, Li ZY, Wallace RN, Eagle RC Jr, Keshgegian AA. Pseudoexfoliative fibrillopathy in visceral organs of a patient with pseudoexfoliation syndrome. Arch Ophthalmol. 1992;110:1757–62.
Thorleifsson G, Magnusson KP, Sulem P, Walters GB, Gudbjartsson DF, Stefansson H, et al. Common sequence variants in the LOX1 gene confer susceptibility to exfoliation glaucoma. Science. 2007;317:1397–400.
Pasutto F, Krumbiegel M, Mardin CY, Paoli D, Lämmer R, Weber BH, et al. Association of LOXL1 common sequence variations in German and Italian patients with pseudoexfoliation syndrome and pseudoexfoliation glaucoma. Invest Ophthalmol Vis Sci. 2008;49:1459–63.
Schlötzer-Schrehardt U, Pasutto F, Sommer P, Hornstra I, Kruse FE, Naumann GO, et al. Genotype-correlated expression of lysyl oxidase-like 1 in ocular tissues of patients with pseudoexfoliation syndrome/glaucoma and normal patients. Am J Ophthalmol. 2008;173:1724–35.
Teus MA, Castejon MS, Calvo MA. Intraocular pressure as a risk factor for visual field loss in pseudoexfoliative and in primary open-angle glaucoma. Ophthalmology. 1998;105:2225–9.
Futa R, Furuyoshi N. Phacodonesis in capsular glaucoma: a clinical and electron microscopie study. Jpn J Ophthalmol. 1989;33:311–7.
Moreno-Montanes J, Avarez Serna A, Alcolea Paredes A. Pseudoexfoliative glaucoma in patients with open-angle glaucoma in the northwest of Spain. Acta Ophthalmol. 1990;68:695–9.
Konstas AGP, Mantziris DA, Stewart WC. Diurnal intraocular pressure in unilateral exfoliation and primary open-angle glaucoma. Arch Ophthalmol. 1997;115:182–5.
Konstas AGP, Stewart WC, Stroman GA, Sine CS. Clinical presentation and initial treatment patterns in patients with exfoliation glaucoma versus primary open-angle glaucoma. Ophthalmic Surg Lasers. 1997;28:111–7.
Konstas AG, Hollo G, Astakhov YS, Teus MA, Akopov EL, Jenkins JN, et al. Factors associated with long-term progression or stability in exfoliation glaucoma. Arch Ophthalmol. 2004;122:29–33.
Grodum K, Heijl A, Bengtsson B. Risk of glaucoma in ocular hypertension with and without pseudoexfoliation. Ophthalmology. 2005;112:386–90.
Leske MC, Heijl A, Hyman L, Bengtsson B, Dong L, Yang Z. Predictors of long-term progression in the early manifest glaucoma trial. Ophthalmology. 2007;114:1965–72.
Ekstrom C, Alm A. Pseudoexfoliation as a risk factor for prevalent open-angle glaucoma. Acta Ophthalmol. 2008;86:741–6.
Futa R. Diagnosis and treatment of exfoliation syndrome and glaucoma. J Eye. 2008;25:961–8.
Azuara-Blanco A, Katz LJ. Dysfunctional filtering blebs. Surv Ophthalmol. 1998;43:93–126.
Fontana H, Nouri-Mahdavi K, Lumba J, Ralli M, Caprioli J. Trabeculectomy with mitomycin C: outocomes and risk factors for failure in phakic open-angle glaucoma. Ophthalmology. 2006;113:930–6.
Shigeeda T, Tomidokoro A, Chen YN, Shirato S, Araie M. Long-term follow-up of initial trebeculectomy with mitomycin C for primary open-angle glaucoma in Japanese patients. J Glaucoma. 2006;15:195–9.
Fukuchi T, Ueda J, Yaoeda K, Suda K, Seki M, Abe H. The outcome of mitomycin C trabeculectomy and laser suture lysis depends on postoperative management. Jpn J Ophthalmol. 2006;50:455–9.
Harms H, Dannheim R. Trabeculotomy: results and problems. Adv Ophthalmol. 1970;22:121–31.
Akimoto M, Tanihara H, Negi A, Nagata M. Surgical effects of trabeculotomy ab externo on adult eyes with primary open-angle glaucoma and pseudoexfoliation syndrome. Arch Ophthalmol. 1993;111:1653–61.
Tanihara H, Honjo M, Inatani M, Honda Y, Ogino N, Ueno S. Trabeculotomy combined with phacoemulusification and implantation of an intraocular lens for the treatment of primary open-angle glaucoma and coexisting cataract. Ophthalmic Surg Lasers. 1997;28:810–7.
Honjo M, Tanihara H, Inatani M, Honda Y, Ogino N, Ueno S, et al. Phacoemulsification, intraocular lens implantation, and trabeculotomy to treat pseudoexfoliation syndrome. J Cataract Refract Surg. 1998;24:781–6.
Mizoguchi T, Nagata M, Matsumura M, Kuroda S, Terauchi H, Tanihara H. Surgical effects of combined trabeculotomy and sinusotomy compared to trabeculotomy alone. Acta Ophthalmol Scand. 2000;78:191–5.
Park M, Hayashi K, Takahashi H, Tanito M, Chihara E. Phaco-viscocanalostomy versus phaco-trabeculotomy: a middle-term study. J Glaucoma. 2006;15:456–61.
Kraznov MM. Externalization of Schlemms’ canal sinusotomy in glaucoma. Br J Ophthalmol. 1968;52:157–61.
Jin GJ, Crandall AS, Jones JJ. Phacotrabeculectomy: assessment of outcomes and surgical improvements. J Cataract Refract Surg. 2007;33:1201–8.
Fukuchi T, Suda K, Tanaka Y, Ueda J, Yaoeda K, Tanaka T, et al. Results of mitomycin C trabeculetomy combined with phacoemulsification and intraocular lens implantation for patients with primary open-angle glaucoma or normal tension glaucoma. Folia Ophthalmol Jpn. 2006;57:672–7.
Allingham RR, Damji K, Freedman S, Moroi S, Shafranov S. Management of the glaucoma patients. In: Shields’ textbook of glaucoma. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2005. p. 437–45.
Drolsum L, Haaskjold E, Sandvig K. Phacoemulsification in eyes with pseudoexfoliation. J Cataract Refract Surg. 1998;24:787–92.
Merkur A, Damji KF, Mintsioulis G, Hodge WG. Intraocular pressure decrease after phacoemulsification in patients with pseudoexfoliation syndrome. J Cataract Refract Surg. 2001;27:528–32.
Shingleton BJ, Heltzer J, O’Donoghue MI. Outcomes of phacoemulsification in patients with and without pseudoexfoliation syndrome. J Cataract Refract Surg. 2003;29:1080–6.
Shingleton BJ, Laul A, Nagao K, Wolff B, O’Donoghue M, Eagan E, et al. Effect of phacoemulsification on intraocular pressure in eyes with pseudoexfoliation: single-surgeon series. J Cataract Refract Surg. 2008;34:1834–41.
Mochizuki K, Jikihara S, Ando Y, Hori N, Yamamoto T, Kitazawa Y. Incidence of delayed onset infection after trabeculectomy with adjunctive mitomycin C or 5-fluorouracil treatment. Br J Ophthalmol. 1997;81:877–83.
Muckley ED, Lehrer RA. Late-onset blebitis/endophthalmitis: incidence and outcomes with mitomycin C. Optom Vis Sci. 2004;81:499–504.
Shields MB, Scroggs MW, Sloop CM, Simmons RB. Clinical and histopathologic observations concerning hypotony after trabeculectomy with adjunctive mitomycin C. Am J Ophthalmol. 1993;116:673–83.
Liebmann JM, Ritch R. Complications of glaucoma filtering surgery. In: Ritch R, Shields MB, Krupin T, editors. The glaucoma. 2nd ed. St. Louis: Mosby; 1996. p. 1703–36.
Minckler DS, Baervelt G, Ramirez MA, Francis BA. Clinical results with the Trabecutome for treatment of open-angle glaucoma. Ophthalmology. 2005;112:962–5.
Spiegel D, Garcia-Feijoo J, Garcia-Sanchez J, Lamielle H. Coexistent primary open-angle glaucoma and cataract: primart analysis of treatment by cataract surgery and the iStent trabecular micro-bypass stent. Adv Ther. 2008;25:453–64.
Lewis RA, von Wolff K, Tetz M, Koerber N, Kearney JR, Shingleton BJ, et al. Canaloplasty: circumferential viscodilation and tensioning of Schlemm’s canal using a flexible microcatheter for the treatment of open-angle glaucoma in adults: interim clinical study analysis. J Cataract Refract Surg. 2007;33:1217–26.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Fukuchi, T., Ueda, J., Nakatsue, T. et al. Trabeculotomy combined with phacoemulsification, intraocular lens implantation and sinusotomy for exfoliation glaucoma. Jpn J Ophthalmol 55, 205–212 (2011). https://doi.org/10.1007/s10384-011-0024-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10384-011-0024-4