Skip to main content

Comparison of long-term results of trabeculectomy and phacotrabeculectomy in patients with pseudoexfoliation glaucoma and primary open-angle glaucoma: a single-center study

International Ophthalmology volume 42, pages 1737–1747 (2022)Cite this article

Abstract

Purpose

To evaluate long-term surgical success and complications in pseudoexfoliation glaucoma (PEXG) and primary open-angle glaucoma (POAG) after trabeculectomy or phacotrabeculectomy.

Methods

96 PEXG eyes and 114 POAG eyes who underwent primary trabeculectomy and phacotrabeculectomy were retrospectively evaluated considering intraocular pressure (IOP), the number of glaucoma medications, surgical success, and rate of complications. Two success criteria were used: Complete success comprised IOP of 5–18 mmHg and 20% reduction of baseline IOP without medication. Qualified success comprised IOP of 5–18 mmHg and 20% reduction of baseline IOP irrespective of medication. Success rates in PEXG and POAG groups, trabeculectomy and phacotrabeculectomy groups, and four groups divided according to surgery and etiology were analyzed via Kaplan–Meier survival analysis.

Results

The complete and qualified success were not different between PEXG and POAG groups. The qualified success curves show a similar pattern among the four groups throughout the follow-up of 1,2,3,5,7 and 9 years. Baseline IOP and the number of medications were similar in all four groups (p = 0.275 and p = 0.209, respectively). IOP levels and the number of medications were not statistically different between the four groups during the follow-up of 2,5 and 7 years. The total number of complications and interventions were similar between PEXG and POAG groups (p = 0.258).

Conclusions

Phacotrabeculectomy is an effective procedure as trabeculectomy with similar surgical success rates and few surgical complications when it comes to treating PAOG and PEXG patients. Both approaches resulted in similar postoperative IOP levels and medication numbers in both groups.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Data availability

Data available on request.

References

  1. Ritch R, Schlötzer-Schrehardt U, Konstas AG (2003) Why is glaucoma associated with exfoliation syndrome? Prog Retin Eye Res 22:253–275

    Article  Google Scholar 

  2. Riga F, Georgalas I, Tsikripis P (2014) Papaconstantinou D (2004) Comparison study of OCT, HRT and VF findings among normal controls and patients with pseudoexfoliation, with or without increased IOP. Clin Ophthalmol 8:2441–2447. https://doi.org/10.2147/OPTH.S75130

    Article  PubMed  PubMed Central  Google Scholar 

  3. Konstas AG, Hollo G, Astakhov YS, Teus MA, Akopov EL, Jenkins JN, Stewart WC (2004) Factors associated with long-term progression or stability in exfoliation glaucoma. Arch Ophthalmol 122:29–33. https://doi.org/10.1001/archopht.122.1.29

    Article  PubMed  Google Scholar 

  4. Lim SH, Cha SC (2017) Long-term outcomes of mitomycin-C trabeculectomy in exfoliative glaucoma versus primary open-angle glaucoma. J Glaucoma 26:303–310

    Article  Google Scholar 

  5. Aboobakar IF, Johnson WM, Stamer WD, Hauser MA, Allingham RR (2017) Major review: exfoliation syndrome; advances in disease genetics, molecular biology, and epidemiology. Exp Eye Res 154:88–103. https://doi.org/10.1016/j.exer.2016.11.011

    CAS  Article  PubMed  Google Scholar 

  6. Plateroti P, Plateroti AM, Abdolrahimzadeh S, Scuderi G (2015) Pseudoexfoliation syndrome and pseudoexfoliation glaucoma: a review of the literature with updates on surgical management. J Ophthalmol 2015:370371. https://doi.org/10.1155/2015/370371

    Article  PubMed  PubMed Central  Google Scholar 

  7. Drolsum L, Ringvold A, Nicolaissen B (2007) Cataract and glaucoma surgery in pseudoexfoliation syndrome: a review. Acta Ophthalmol Scand 85:810–821

    Article  Google Scholar 

  8. Koliakos GG, Schlötzer-Schrehardt U, Konstas AG, Bufidis T, Georgiadis N, Dimitriadou A (2001) Transforming and insulin-like growth factors in the aqueous humour of patients with exfoliation syndrome. Graefes Arch Clin Exp Ophthalmol 239:482–487. https://doi.org/10.1007/s004170100287

    CAS  Article  PubMed  Google Scholar 

  9. Schlötzer-Schrehardt U, Zenkel M, Küchle M, Sakai LY, Naumann GO (2001) Role of transforming growth factor-beta1 and its latent form binding protein in pseudoexfoliation syndrome. Exp Eye Res 73:765–780. https://doi.org/10.1006/exer.2001.1084

    CAS  Article  PubMed  Google Scholar 

  10. Koliakos GG, Konstas AG, Schlötzer-Schrehardt U, Hollo G, Mitova D, Kovatchev D, Maloutas S, Georgiadis N (2004) Endothelin-1 concentration is increased in the aqueous humour of patients with exfoliation syndrome. Br J Ophthalmol 88:523–527. https://doi.org/10.1136/bjo.2003.028290

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  11. Wang W, He M, Zhou M, Zhang X (2014) Ocular pseudoexfoliation syndrome and vascular disease: a systematic review and meta-analysis. PLoS ONE 9:e92767. https://doi.org/10.1371/journal.pone.0092767

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  12. Tarkkanen A (2008) Is exfoliation syndrome a sign of systemic vascular disease? Acta Ophthalmol 86:832–836

    Article  Google Scholar 

  13. Serguhn S, Spiegel D (1999) Comparison of postoperative recovery after trabeculectomy for pseudoexfoliation glaucoma and chronic primary open angle glaucoma. Klin Monatsb Augenheilkd 215:281–286

    CAS  Article  Google Scholar 

  14. Törnqvist G, Drolsum LK (1991) Trabeculectomies. Acta Ophthalmol 69:450–454

    Article  Google Scholar 

  15. Ehrnrooth P, Lehto I, Puska P, Laatikainen L (2002) Long-term outcome of trabeculectomy in terms of intraocular pressure. Acta Ophthalmol Scand 80:267–271. https://doi.org/10.1034/j.1600-0420.2002.800307.x

    Article  PubMed  Google Scholar 

  16. Landa G, Pollack A, Rachmiel R, Bukelman A, Marcovich A, Zalish M (2005) Results of combined phacoemulsification and trabeculectomy with mitomycin C in pseudoexfoliation versus non-pseudoexfoliation glaucoma. Graefes Arch Clin Exp Ophthalmol 243:1236–1240. https://doi.org/10.1007/s00417-005-0013-8

    CAS  Article  PubMed  Google Scholar 

  17. Shingleton BJ, Wooler KB, Bourne CI, O’Donoghue MW (2011) Combined cataract and trabeculectomy surgery in eyes with pseudoexfoliation glaucoma. J Cataract Refract Surg 37:1961–1970. https://doi.org/10.1016/j.jcrs.2011.05.036

    Article  PubMed  Google Scholar 

  18. Casson RJ, Salmon JF (2001) Combined surgery in the treatment of patients with cataract and primary open-angle glaucoma. J Cataract Refract Surg 27:1854–1863

    CAS  Article  Google Scholar 

  19. Sample PA, Girkin CA, Zangwill LM, Jain S, Racette L, Becerra LM, Weinreb RN, Medeiros FA, Wilson MR, De León-Ortega J, Tello C, Bowd C, Liebmann JM (2009) African descent and glaucoma evaluation study group. The African descent and glaucoma evaluation study (ADAGES): design and baseline data. Arch Ophthalmol 127(9):1136–1145

    Article  Google Scholar 

  20. Ritch R (2014) Ocular and systemic manifestations of exfoliation syndrome. J Glaucoma 23:S1-8

    Article  Google Scholar 

  21. Staging of Visual Field Defects. (2014) Terminology and guidelines for glaucoma. 4. Savona: PubliComm. p 64

  22. Nie L, Fu L, Chan YK, Fang A, Pan W (2020) Combined phacoemulsification with goniosynechialysis under ophthalmic endoscope for primary angle-closure glaucoma after failed trabeculectomy. J Glaucoma 29:941–947. https://doi.org/10.1097/IJG.0000000000001579

    Article  PubMed  Google Scholar 

  23. Heuer DK, Barton K, Grehn F, Shaarawy T, Sherwood M (2009) Consensus on definitions of success. Guidelines on design and reporting of glaucoma surgical trials 15

  24. Li F, Tang G, Zhang H, Yan X, Ma L, Geng Y (2020) The effects of trabeculectomy on pseudoexfoliation glaucoma and primary open-angle glaucoma. J Ophthalmol 23(2020):1723691. https://doi.org/10.1155/2020/1723691

    CAS  Article  Google Scholar 

  25. Pelitli Gürlü V, Güçlü H, Özal A, Benian Ö, Alimgil L (2018) Comparison of long-term results of trabeculectomy to treat pseudoexfoliative glaucoma and primary open angle glaucoma. Int J Ophthalmol 11:66–70. https://doi.org/10.18240/ijo.2018.01.12

    Article  PubMed  PubMed Central  Google Scholar 

  26. Scott IU, Greenfield DS, Schiffman J, Nicolela MT, Rueda JC, Tsai JC, Palmberg PF (1998) Outcomes of primary trabeculectomy with the use of adjunctive mitomycin. Arch Ophthalmol 116:286–291. https://doi.org/10.1001/archopht.116.3.286

    CAS  Article  PubMed  Google Scholar 

  27. Yuasa Y, Sugimoto Y, Hirooka K, Ohkubo S, Higashide T, Sugiyama K, Kiuchi Y (2020) Effectiveness of trabeculectomy with mitomycin C for glaucomatous eyes with low intraocular pressure on treatment eye drops. Acta Ophthalmol 98:e81–e87. https://doi.org/10.1111/aos.14195

    CAS  Article  PubMed  Google Scholar 

  28. Murthy SK, Damji KF, Pan Y, Hodge WG (2006) Trabeculectomy and phacotrabeculectomy, with mitomycin-C, show similar two-year target IOP outcomes. Can J Ophthalmol 41:51–59. https://doi.org/10.1016/S0008-4182(06)80067-0

    Article  PubMed  Google Scholar 

  29. Ogata-Iwao M, Inatani M, Takihara Y, Inoue T, Iwao K, Tanihara H (2013) A prospective comparison between trabeculectomy with mitomycin C and phacotrabeculectomy with mitomycin C. Acta Ophthalmol 91:e500–e501. https://doi.org/10.1111/aos.12133

    Article  PubMed  Google Scholar 

  30. Lochhead J, Casson RJ, Salmon JF (2003) Long term effect on intraocular pressure of phacotrabeculectomy compared to trabeculectomy. Br J Ophthalmol 87:850–852. https://doi.org/10.1136/bjo.87.7.850

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  31. Damji KF, Behki R, Wang L, Target IOP Workshop participants (2003) Canadian perspectives in glaucoma management: setting target intraocular pressure range. Can J Ophthalmol 38:189–97. https://doi.org/10.1016/s0008-4182(03)80060-1

    Article  PubMed  Google Scholar 

  32. Graf NE, Müller M, Gerlach F, Meyer ML, Philipp S, Distelmaier P, Klink T, Schönfeld CL (2019) Comparison of 2-year-results of mitomycin C-augmented trabeculectomy with or without cataract extraction in glaucoma patients. Can J Ophthalmol 54:347–354. https://doi.org/10.1016/j.jcjo.2018.07.006

    Article  Google Scholar 

  33. Kleinmann G, Katz H, Pollack A, Schechtman E, Rachmiel R, Zalish M (2002) Comparison of trabeculectomy with mitomycin C with or without phacoemulsification and lens implantation. Ophthalmic Surg Lasers 33:102–108

    Article  Google Scholar 

  34. Guggenbach M, Mojon DS, Böhnke M (1999) Evaluation of phacotrabeculectomy versus trabeculectomy alone. Ophthalmologica 213:367–370

    CAS  Article  Google Scholar 

  35. Lam D, Wechsler DZ (2021) Five-year outcomes of trabeculectomy and phacotrabeculectomy. Cureus 13(1):e12950. https://doi.org/10.7759/cureus.12950

    Article  PubMed  PubMed Central  Google Scholar 

  36. Hong S, Park K, Ha SJ, Yeom HY, Seong GJ, Hong YJ (2007) Long-term intraocular pressure control of trabeculectomy and triple procedure in primary open angle glaucoma and chronic primary angle closure glaucoma. Ophthalmologica 221:395–401. https://doi.org/10.1159/000107499

    Article  PubMed  Google Scholar 

  37. Bellucci R, Perfetti S, Babighian S, Morselli S, Bonomi L (1997) Filtration and complications after trabeculectomy and after phaco-trabeculectomy. Acta Ophthalmol Scand Suppl 224:44–45. https://doi.org/10.1111/j.1600-0420.1997.tb00473.x

    Article  Google Scholar 

  38. Peräsalo R, Flink T, Lehtosalo J, Ralli R, Sulonen (1997) Surgical outcome of phaco-emulsification combined with trabeculectomy in 243 eyes. Acta Ophthalmol Scand 75:581–3. https://doi.org/10.1111/j.1600-0420.1997.tb00153.x

    Article  PubMed  Google Scholar 

  39. Jung JL, Isida-Llerandi CG, Lazcano-Gomez G, SooHoo JR, Kahook MY (2014) Intraocular pressure control after trabeculectomy, phacotrabeculectomy and phacoemulsification in a hispanic population. J Curr Glaucoma Pract 8:67–74. https://doi.org/10.5005/jp-journals-10008-1164

    Article  Google Scholar 

  40. Jampel HD, Friedman DS, Lubomski LH, Kempen JH, Quigley H, Congdon N, Levkovitch-Verbin H, Robinson KA, Bass EB (2002) Effect of technique on intraocular pressure after combined cataract and glaucoma surgery: an evidence-based review. Ophthalmology 109:2215–24. https://doi.org/10.1016/s0161-6420(02)01439-2

    Article  PubMed  Google Scholar 

  41. Verge’s C, Cazal J, Lavin C (2005) Surgical strategies in patients with cataract and glaucoma. Curr Opin Ophthalmol 16:44–52

    Article  Google Scholar 

Download references

Funding

No funding was received for conducting this study. No financial disclosures.

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Kocaeli University Hospital, Kocaeli University Medical Faculty, Kocaeli, Turkey

    Büşra Yilmaz Tugan, Nursen Yuksel & Sevgi Subasi

  2. Ophthalmology Clinic, Tuzla State Hospital, Istanbul, Turkey

    Enes Kesim

Authors
  1. Büşra Yilmaz Tugan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nursen Yuksel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Enes Kesim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sevgi Subasi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

BYT, NY, and EK involved in conceptualization; BYT, NY, and SS involved in methodology; BYT and EK involved in formal analysis and investigation; BYT involved in writing—original draft preparation; BYT, NY, EK, and SS involved in writing—review and editing; BYT and NY involved in supervision. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Büşra Yilmaz Tugan.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to declare that are relevant to the content of this article.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (KÜ-GOKAEK Project No: 2020/273) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Yilmaz Tugan, B., Yuksel, N., Kesim, E. et al. Comparison of long-term results of trabeculectomy and phacotrabeculectomy in patients with pseudoexfoliation glaucoma and primary open-angle glaucoma: a single-center study. Int Ophthalmol 42, 1737–1747 (2022). https://doi.org/10.1007/s10792-021-02169-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10792-021-02169-2

Keywords

  • Trabeculectomy
  • Phacotrabeculectomy
  • Primary open-angle glaucoma
  • Pseudoexfoliation glaucoma
  • Combined surgery