Comparison of phacotrabeculectomy and sequential surgery in the treatment of chronic angle-closure glaucoma coexisted with cataract

AIM： To compare the safety and effectiveness of phacotrabeculectomy versus sequential surgery in chronic angle-closure glaucoma（CACG） with coexisting cataract.·METHODS： One hundred and sixty-two CACG patients（162 eyes） were retrospectively analyzed. Of them, 87patients（87 eyes） in group A had underwent phacotrabeculectomy with intraocular lens（IOL）implantation, and 75 patients（75 eyes） in group B had underwent sequential surgery with IOL implanted. Best-corrected visual acuity（BCVA）, intraocular pressure（IOP）, complications and anterior chamber angle（ACA）were measured.· RESULTS： Demographic characteristics of the two groups were similar. A mean follow-up period was 15±6mo（range 13 to 24mo）, a mean IOP of 12.14 ±5.32 mm Hg in group A and 11.38 ±4.06 mm Hg in group B（P =0.84） at the last follow up. The Kaplan-Meier analysis revealed that the cumulative probability of success in both groups was similar（P =0.61）. Anterior uveitis and hypotony were the most common complications in group A, whereas group B experienced shallow anterior chamber with trabeculectomy. With the exception of anterior uveitis, no complications occurred to 11 trabeculectomized eyes. All postoperative measurements of anterior chamber showed statistically significant differences in each group according to the preoperative data（P〈 0.05）. However,fewer changes occurred in group B than in group A.· CONCLUSION： Phacotrabeculectomy and sequential surgery exhibit similar IOP reduction, visual recovery,and complications when treating CACG patients with cataract. However, for a wider ACA, phacotrabeculectomy has demonstrated higher effectiveness than sequential surgery.

Predictability of refraction following immediate sequential bilateral cataract surgery(ISBCS)performed under general anaesthesia

Background:To evaluate the predictability of refraction following immediate sequential bilateral cataract surgery(ISBCS)performed under general anaesthesia.Methods:This is a retrospective review of all ISBCS performed at Kantonsspital Winterthur,Switzerland,between April 2000 and September 2013.The case notes of 250 patients were reviewed.Patients having full refraction reported(110 patients/220 eyes)were included.210(95%)eyes had a straight forward phacoemulsification with posterior chamber intraocular lens implantation,seven eyes had a planned extracapsular cataract extraction(ECCE);three eyes had an intracapsular cataract extraction.Results:Both eyes of 110 patients(64 women,46 men)with a mean age of 79.0 years,standard deviation(SD)±11.4(range 26 to 97 years)were included.Median preoperative best corrected visual acuity(BCVA)was 0.5 LogMAR in the first eye,the interquartile range(IQR)was[0.4,1.2];0.7 LogMAR in the second eye with IQR[0.4,1.8].At one month,the median BCVA was 0.2 LogMAR,IQR[0.1,0.3]in the first eye,median BCVA was 0.1 LogMAR and IQR[0.0,0.5]in the second eye.There were 3 eyes(3%)that lost 3 lines or more in BCVA at one month(control vs.pre-operatively).In all three cases,poor visual acuity had been recorded pre-operatively(>1 LogMAR).Achieved refraction was within±1.0 D of the target in 83%of eyes.There were only 5%(n=6)of cases where if delayed sequential bilateral extraction had been performed could potentially intraocular lens(IOL)choice have been adjusted,in four of these cases,target refraction was within±1.0 D in the second eye.Conclusions:ISBCS performed under general anaesthesia achieves target refraction in 83%of eyes after consideration of complications,ocular co-morbidities and systemic restrictions.In the majority of cases where IOL power calculation could be considered,the achieved refraction of the second surgical eye was within±1.0 D of intended refraction.This undermines the utility of IOL power adjustments in the second surgical eye.