C M Lederer1. 1. Department of Ophthalmology Eye Foundation, University of Missouri-Kansas City School of Medicine, USA.
Abstract
PURPOSE: Cataract and glaucoma commonly coexist in elderly patients and present complex treatment options. This study investigates the results of simultaneous treatment of both conditions using phacoemulsification with posterior chamber lens implant and mitomycin-augmented trabeculectomy (combined surgery). METHODS: A retrospective analysis was performed of 56 consecutive patients who had undergone combined surgery. Fifty-one (91%) of 56 patients had fornix-based conjunctival flaps resutured at the limbus. A variety of postoperative interventional techniques (mechanical and pharmacologic) were used to encourage the achievement of successful filtering blebs. RESULTS: All patients had follow-up of at least 12 months. The mean preoperative intraocular pressure (IOP) was 20.2 mmHg (range, 14-43 mmHg) and the mean postoperative IOP was 10.7 mmHg (range, 4-17 mmHg). Fifty-three (95%) of 56 patients had IOPs of 15 mmHg or less at the completion of follow-up. All except two patients (96%) were able to discontinue all glaucoma medications. The filtering blebs that resulted from the fornix-based conjunctival flap procedures were predominantly large, diffuse, and noncystic. Best-corrected visual acuity was 20/40 or better in 47 (84%) of 56 of patients. CONCLUSION: Control of IOP and improvement of visual acuity can be achieved in a high percentage of patients with coexisting cataract and glaucoma by performing combined surgery using intraoperative mitomycin and fornix-based conjunctival flaps resutured to the limbus. The filtering blebs illustrated a distinctive morphology compared with blebs resulting from limbus-based conjunctival flap procedures.
PURPOSE:Cataract and glaucoma commonly coexist in elderly patients and present complex treatment options. This study investigates the results of simultaneous treatment of both conditions using phacoemulsification with posterior chamber lens implant and mitomycin-augmented trabeculectomy (combined surgery). METHODS: A retrospective analysis was performed of 56 consecutive patients who had undergone combined surgery. Fifty-one (91%) of 56 patients had fornix-based conjunctival flaps resutured at the limbus. A variety of postoperative interventional techniques (mechanical and pharmacologic) were used to encourage the achievement of successful filtering blebs. RESULTS: All patients had follow-up of at least 12 months. The mean preoperative intraocular pressure (IOP) was 20.2 mmHg (range, 14-43 mmHg) and the mean postoperative IOP was 10.7 mmHg (range, 4-17 mmHg). Fifty-three (95%) of 56 patients had IOPs of 15 mmHg or less at the completion of follow-up. All except two patients (96%) were able to discontinue all glaucoma medications. The filtering blebs that resulted from the fornix-based conjunctival flap procedures were predominantly large, diffuse, and noncystic. Best-corrected visual acuity was 20/40 or better in 47 (84%) of 56 of patients. CONCLUSION: Control of IOP and improvement of visual acuity can be achieved in a high percentage of patients with coexisting cataract and glaucoma by performing combined surgery using intraoperative mitomycin and fornix-based conjunctival flaps resutured to the limbus. The filtering blebs illustrated a distinctive morphology compared with blebs resulting from limbus-based conjunctival flap procedures.