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Abstract #5854 Published in IGR 2-1
Prospective intrapatient comparison of extracapsular cataract extraction and lens implantation with and without trabeculectomy
Bobrow JCAmerican Journal of Ophthalmology 2000; 129: 291-296
PURPOSE: To determine whether extracapsular cataract extraction and posterior chamber lens implantation combined with trabeculectomy provides better long-term results than extracapsular cataract extraction and lens implantation alone in a group of patients with primary open-angle glaucoma and cataract. METHODS: In a prospective, randomized clinical trial, 35 patients with bilateral, symmetric, primary open-angle glaucoma and visually disabling cataracts were randomly selected to undergo surgery with trabeculectomy in one eye and without in the other. All procedures were performed by a single surgeon in a private practice setting with follow-up for more than five years in all cases. RESULTS: After an average of 87 months of follow-up, extracapsular cataract extraction and posterior chamber lens implantation reduced intraocular pressure by 4.4±3.3 mmHg, reduced the number of medications by 1.28±0.86, increased diopter vector of astigmatism by 1.49, and was associated with visual field loss in six of 35 eyes. After an average of 80 months of follow-up, extracapsular cataract extraction and posterior chamber lens implantation with trabeculectomy reduced intraocular pressure by 8.2±4.6 mmHg (p=0.0001), reduced the number of medications by 1.76±0.82 (p=0.0002), increased diopter vector of astigmatism by 1.14, and was associated with visual field loss in one eye (p=0.05). Both groups had similar improvement in visual acuity and perioperative complications. CONCLUSIONS: Extracapsular cataract extraction and posterior chamber lens implantation with trabeculectomy was beneficial in the long-term control of intraocular pressure and in prevention of visual field loss. This procedure should be considered for patients in whom long-term pressure control at a lower level would be beneficial in preventing further optic nerve damage.
Dr. J.C. Bobrow, Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, MO, USA. bobrowj@pol.net
Classification:
12.8.1 Without tube implant (Part of: 12 Surgical treatment > 12.8 Filtering surgery)
12.14.3 Phacoemulsification (Part of: 12 Surgical treatment > 12.14 Combined cataract extraction and glaucoma surgery)
12.14.2 Extracapsular (Part of: 12 Surgical treatment > 12.14 Combined cataract extraction and glaucoma surgery)
