Skip to main content

Advertisement

SpringerLink
Log in

Success rates of 2-site phacoemulsification combined with fornix-based trabeculectomy using mitomycin C for primary angle-closure glaucoma and primary open-angle glaucoma in an Asian population

  • Clinical Investigation
  • Published:
Japanese Journal of Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To determine the long-term outcomes of 2-site phacoemulsification combined with fornix-based trabeculectomy using mitomycin C (MMC) for primary angle-closure glaucoma (PACG) and primary open-angle glaucoma (POAG) in an Asian population.

Methods

We reviewed the records of all patients with POAG or PACG who underwent phacoemulsification with trabeculectomy using MMC from January 2008 through December 2010 in a tertiary ophthalmology unit in Singapore. The primary outcome measure was cumulative success rates defined as complete [intraocular pressure (IOP) <21, 18, 15 mmHg without medication] and qualified (IOP <21, 18, 15 mmHg with at least 1 medication) success.

Results

In total, 168 eyes (110 POAG and 58 PACG) were included (43.5% female; mean age ± SD, 68.3 ± 8.2 years). The respective 3-year qualified success rates were 88.4, 79.3, and 52.5% for IOP <21, 18, and 15 mmHg. The corresponding complete success rates were 79.0, 70.9, and 51.1%. The mean 3-year postoperative IOP was 14.5 ± 4.4 mmHg, and the IOP reduction was significantly greater for PACG than for POAG eyes (P = 0.006). After surgery, the mean number of medications was significantly reduced and visual acuity, significantly improved (both P < 0.001). Occurrence of postoperative complications, higher number of topical medications, younger age, and presence of diabetes mellitus were significant risk factors for surgical failure.

Conclusion

Two-site phacoemulsification combined with fornix-based trabeculectomy using MMC is a good surgical approach for Asian eyes with concomitant mild-to-moderate primary glaucoma and cataracts.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Tham YC, Li X, Wong TY, Quigley HA, Aung T, Cheng CY. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology. 2014;121:2089–90.

    Article  Google Scholar 

  2. Bourne RR, Jonas JB, Flaxman SR, Keeffe J, Leasher J, Naidoo K, et al. Prevalence and causes of vision loss in high-income countries and in Eastern and Central Europe: 1990–2010. Br J Ophthalmol. 2014;98:629–38.

    Article  PubMed  Google Scholar 

  3. Landers J, Martin K, Sarkies N, Bourne R, Watson P. A twenty-year follow-up study of trabeculectomy: risk factors and outcomes. Ophthalmology. 2012;119:694–702.

    Article  PubMed  Google Scholar 

  4. Ehrnrooth P, Lehto I, Puska P, Laatikainen L. Long-term outcome of trabeculectomy in terms of intraocular pressure. Acta Ophthalmol Scand. 2002;80:267–71.

    Article  PubMed  Google Scholar 

  5. Park HJ, Weitzman M, Caprioli J. Temporal corneal phacoemulsification combined with superior trabeculectomy: a retrospective case-control study. Arch Ophthalmol. 1997;115:318–23.

    Article  CAS  PubMed  Google Scholar 

  6. Caprioli J, Park HJ, Weitzman M. Temporal corneal phacoemulsification combined with superior trabeculectomy: a controlled study. Trans Am Ophthalmol Soc. 1996;94:451–63 (discussion 463–8).

    CAS  PubMed  PubMed Central  Google Scholar 

  7. Shin DH, Hughes BA, Song MS, Kim C, Yang KJ, Shah MI, et al. Primary glaucoma triple procedure with or without adjunctive mitomycin: prognostic factors for filtration failure. Ophthalmology. 1996;103:1925–33.

    Article  CAS  PubMed  Google Scholar 

  8. Dally L, Ederer F, Gaasterland D, Blackwell B, VanVeldhuisen P, Allen R, et al. The Advanced Glaucoma Intervention Study (AGIS): 11. Risk factors for failure of trabeculectomy and argon laser trabeculoplasty. Am J Ophthalmol. 2002;134:481–98.

    Article  Google Scholar 

  9. Sng CC, See JS, Ngo CS, Singh M, Chan YH, Aquino MC, et al. Changes in retinal nerve fibre layer, optic nerve head morphology, and visual field after acute primary angle closure. Eye (Lond). 2011;25:619–25.

    Article  CAS  Google Scholar 

  10. Foster PJ, Buhrmann R, Quigley HA, Johnson GJ. The definition and classification of glaucoma in prevalence surveys. Br J Ophthalmol. 2002;86:238–42.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Tan YL, Tsou PF, Tan GS, Perera SA, Ho CL, Wong TT, et al. Postoperative complications after glaucoma surgery for primary angle-closure glaucoma vs primary open-angle glaucoma. Arch Ophthalmol. 2011;129:987–92.

    Article  PubMed  Google Scholar 

  12. Chen DZ, Koh V, Sng C, Aquino MC, Chew P. Complications and outcomes of primary phacotrabeculectomy with mitomycin C in a multi-ethnic Asian population. PLoS One. 2015;10:e0118852.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Shaarawy TM, Sherwood MB, Grehn F. Guidelines on design and reporting of glaucoma surgical trials. Amsterdam: Kugler Publications; 2009.

    Google Scholar 

  14. Friedman DS, Jampel HD, Lubomski LH, Kempen JH, Quigley H, Congdon N, et al. Surgical strategies for coexisting glaucoma and cataract: an evidence-based update. Ophthalmology. 2002;109:1902–13.

    Article  PubMed  Google Scholar 

  15. Verges C, Cazal J, Lavin C. Surgical strategies in patients with cataract and glaucoma. Curr Opin Ophthalmol. 2005;16:44–52.

    Article  PubMed  Google Scholar 

  16. Cotran PR, Roh S, McGwin G. Randomized comparison of 1-site and 2-site phacotrabeculectomy with 3-year follow-up. Ophthalmology. 2008;115(447–54):e1.

    Google Scholar 

  17. Ogata-Iwao M, Inatani M, Takihara Y, Inoue T, Iwao K, Tanihara H. A prospective comparison between trabeculectomy with mitomycin C and phacotrabeculectomy with mitomycin C. Acta Ophthalmol. 2013;91:e500–1.

    Article  PubMed  Google Scholar 

  18. Vijaya L, David RL. Safety and efficacy of single-site phacotrabeculectomy with mitomicin C using nylon and polyglactin suture for scleral tunnel closure. J Glaucoma. 2015;24:e64–8.

    Article  PubMed  Google Scholar 

  19. Rao HL, Maheshwari R, Senthil S, Prasad KK, Garudadri CS. Phacotrabeculectomy without mitomycin C in primary angle-closure and open-angle glaucoma. J Glaucoma. 2011;20:57–62.

    Article  PubMed  Google Scholar 

  20. Lai JS, Tham CC, Chan JC, Lam DS. Phacotrabeculectomy in treatment of primary angle-closure glaucoma and primary open-angle glaucoma. Jpn J Ophthalmol. 2004;48:408–11.

    Article  PubMed  Google Scholar 

  21. Hayashi K, Hayashi H, Nakao F, Hayashi F. Changes in anterior chamber angle width and depth after intraocular lens implantation in eyes with glaucoma. Ophthalmology. 2000;107:698–703.

    Article  CAS  PubMed  Google Scholar 

  22. Hayashi K, Hayashi H, Nakao F, Hayashi F. Effect of cataract surgery on intraocular pressure control in glaucoma patients. J Cataract Refract Surg. 2001;27:1779–86.

    Article  CAS  PubMed  Google Scholar 

  23. Foster PJ, Johnson GJ. Glaucoma in China: how big is the problem? Br J Ophthalmol. 2001;85:1277–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Tham CC, Kwong YY, Leung DY, Lam SW, Li FC, Chiu TY, et al. Phacoemulsification versus combined phacotrabeculectomy in medically controlled chronic angle closure glaucoma with cataract. Ophthalmology. 2008;115(2167–73):e2.

    Google Scholar 

  25. Tham CC, Kwong YY, Leung DY, Lam SW, Li FC, Chiu TY, et al. Phacoemulsification versus combined phacotrabeculectomy in medically uncontrolled chronic angle closure glaucoma with cataracts. Ophthalmology. 2009;116:725–31.

    Article  PubMed  Google Scholar 

  26. Broadway DC, Grierson I, O’Brien C, Hitchings RA. Adverse effects of topical antiglaucoma medication. II. The outcome of filtration surgery. Arch Ophthalmol. 1994;112:1446–54.

    Article  CAS  PubMed  Google Scholar 

  27. Sherwood MB, Grierson I, Millar L, Hitchings RA. Long-term morphologic effects of antiglaucoma drugs on the conjunctiva and Tenon’s capsule in glaucomatous patients. Ophthalmology. 1989;96:327–35.

    Article  CAS  PubMed  Google Scholar 

  28. Broadway DC, Grierson I, O’Brien C, Hitchings RA. Adverse effects of topical antiglaucoma medication. I. The conjunctival cell profile. Arch Ophthalmol. 1994;112:1437–45.

    Article  CAS  PubMed  Google Scholar 

  29. Benson SE, Mandal K, Bunce CV, Fraser SG. Is post-trabeculectomy hypotony a risk factor for subsequent failure? A case control study. BMC Ophthalmol. 2005;5:1–5.

    Article  Google Scholar 

  30. Wong JS, Yip L, Tan C, Chew P. Trabeculectomy survival with and without intra-operative 5-fluorouracil application in an Asian population. Aust N Z J Ophthalmol. 1998;26:283–8.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This study was presented as an oral poster on September 14, 2014 at the XXXII Congress of the European Society of Cataract & Refractive Surgeons (ESCRS) London 2014.

Conflicts of interest

V. Koh, None; D. Chen, None; C. M. Aquino, None; J. Aduan, None; C. Sng, None; L. S. Chee, None; P. Chew, None.

Author information

Authors and Affiliations

  1. Department of Ophthalmology, National University Health System, 1E Kent Ridge Road, Level 7, NUHS Tower Block, Singapore, 119228, Singapore

    Victor Koh, David Chen, Cecilia Maria Aquino, Joel Aduan, Chelvin Sng, Loon Seng Chee & Paul Chew

Authors
  1. Victor Koh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cecilia Maria Aquino
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Joel Aduan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Chelvin Sng
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Loon Seng Chee
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Paul Chew
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Victor Koh.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Koh, V., Chen, D., Aquino, C.M. et al. Success rates of 2-site phacoemulsification combined with fornix-based trabeculectomy using mitomycin C for primary angle-closure glaucoma and primary open-angle glaucoma in an Asian population. Jpn J Ophthalmol 61, 245–252 (2017). https://doi.org/10.1007/s10384-017-0502-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10384-017-0502-4

Keywords

Search

Navigation