Influence of Prostaglandin Analogue on Outcome after Combined Cataract Surgery and Trabecular Aspiration in Pseudoexfoliative Glaucoma

Abstract

Purpose

The aim of this study was to analyze the postoperative outcome and risk profile after combined clear cornea phacoemulsification and trabecular aspiration in the treatment of pseudoexfoliative glaucoma (PEX) associated with cataract.

Methods

In this retrospective study, 69 eyes of 60 patients with visually significant cataract and PEX were treated with small-incision cataract surgery combined with trabecular aspiration. The intraocular pressure (IOP), number of antiglaucoma eyedrops before and after surgery, as well as complications were measured at all postoperative visits (1 day, 7 days, 6 weeks, 6 months, 12 months).

Results

There was a statistically significant decrease in postoperative IOP during the follow-up period. There was no significant difference in the number of medications being used after 6 weeks follow-up. Six months and 12 months after surgery, the number of antiglaucoma eyedrops decreased significantly. Complications were fibrinotic iritis in 4 eyes (5.9%), cystoid macular edema in 3 eyes (4.4%), and hyphema in 1 eye (1.4%). Fibrinotic iritis and macular edema were present in only 37 of 69 eyes that were treated with prostaglandin analogues.

Conclusions

Small-incision cataract surgery combined with trabecular aspiration in cases of PEX associated with cataract is effective in IOP reduction over a 1-year follow-up. Prostaglandin analogues may increase the risk of postoperative macular edema and fibrinotic iritis. Preoperative medication exchange may be considered.

Keywords

Fibrinotic iritis Macular edema Phacoemulsification Prostaglandin analogues Pseudoexfoliation glaucoma Trabecular aspiration

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References

Ritch

, Schloetzer-Schrehardt

. Exfoliation syndrome. Surv Ophthalmol 2001; 45: 265–315.

Thorleifsson

, Magnusson

K.P.

, Sulem

. Common sequence variants in the LOXL1 gene confer susceptibility to exfoliation glaucoma. Science 2007; 317: 1397–400.

Ritch

. Exfoliation syndrome: the most common identifiable cause of open-angle glaucoma. J Glaucoma 1994; 3: 176–7.

Georgopoulos

G.T.

, Chalkiadakis

, Livir-Rallatos

, Theodossiadis

P.G.

, Theodossiadis

G.P.

. Combined clear cornea phacoemulsification and trabecular aspiration in the treatment of pseudoexfoliative glaucoma associated with cataract. Graefes Arch Clin Exp Ophthalmol 2000; 238: 816–21.

Jacobi

P.C.

, Krieglstein

G.K.

. Trabecular aspiration. A new surgical method for improving chamber angle facility in pseudoexfoliation glaucoma. Ophthalmologe 1995; 92: 550–5.

Jacobi

P.C.

, Krieglstein

G.K.

. Trabecular aspiration. A new mode to treat pseudoexfoliation glaucoma. Invest Ophthalmol Vis Sci 1995; 36: 2270–6.

Jacobi

P.C.

, Dietlein

T.S.

, Krieglstein

G.K.

. Bimanual trabecular aspiration in pseudoexfoliation glaucoma: an alternative in nonfiltering glaucoma surgery. Ophthalmology 1998; 105: 886–94.

Drolsum

, Ringvold

, Nicolaissen

. Cataract and glaucoma surgery in pseudoexfoliation syndrome: a review. Acta Ophthalmol Scand 2007; 85: 810–21.

Merkur

, Damji

K.F.

, Mintsioulis

, Hodge

W.G.

. Intraocular pressure decrease after phacoemulsification in patients with pseudoexfoliation syndrome. J Cataract Refract Surg 2001; 27: 528–32.

10.

Damji

K.F.

, Konstas

A.G.

, Liebmann

J.M.

. Intraocular pressure following phacoemulsification in patients with and without exfoliation syndrome: a 2 year prospective study. Br J Ophthalmol 2006; 90: 1014–8.

11.

Shingleton

B.J.

, Laul

, Nagao

. Effect of phacoemulsification on intraocular pressure in eyes with pseudoexfoliation: single-surgeon series. J Cataract Refract Surg 2008; 34: 1834–41.

12.

Altan-Yaycioglu

, Canan

, Pelit

, Akova

Y.A.

. Intraocular pressure after phacoemulsification in eyes with pseudoexfoliation. J Cataract Refract Surg 2009; 35: 952–4.

13.

Jea

S.Y.

, Francis

B.A.

, Vakili

, Filippopoulos

, Rhee

D.J.

. Ab interno trabeculectomy versus trabeculectomy for open-angle glaucoma. Ophthalmology 2012; 119: 36–42.

14.

Jampel

H.D.

, Musch

D.C.

, Gillespie

B.W.

, Lichter

P.R.

, Wright

M.M.

, Guire

K.E.

; Collaborative Initial Glaucoma Treatment Study Group. Perioperative complications of trabeculectomy in the Collaborative Initial Glaucoma Treatment Study (CIGTS). Am J Ophthalmol 2005; 140: 16–22.

15.

Gedde

S.J.

, Herndon

L.W.

, Brandt

J.D.

, Budenz

D.L.

, Feuer

W.J.

, Schiffman

J.C.

; Tube Versus Trabeculectomy Study Group. Surgical complications in the Tube Versus Trabeculectomy Study during the first year of follow-up. Am J Ophthalmol 2007; 143: 23–31.

16.

Jacobi

P.C.

, Dietlein

T.S.

, Krieglstein

G.K.

. Comparative study of trabecular aspiration vs trabeculectomy in glaucoma triple procedure to treat pseudoexfoliation glaucoma. Arch Ophthalmol 1999; 117: 1311–8.

17.

Küchle

, Nguyen

N.X.

, Hannappel

, Beck

, Ho

S.T.

, Naumann

G.O.

. [Tyndallometry with the laser flare cell meter and biochemical protein determination in the aqueous humor of eyes with pseudoexfoliation syndrome.] Ophthalmologe 1994; 91: 578–84.

18.

Schumacher

, Nguyen

N.X.

, Küchle

, Naumann

G.O.

. Quantification of aqueous flare after phacoemulsification with intraocular lens implantation in eyes with pseudoexfoliation syndrome. Arch Ophthalmol 1999; 117: 733–5.

19.

Mataftsi

, Tsaousis

K.T.

, Tsinopoulos

I.T.

, Dimitrakos

S.A.

. Survey of perioperative prostaglandin analogue administration during cataract surgery in Greece. Int Ophthalmol 2012; 32: 97–8.

20.

Ting

J.L.

, Damji

K.F.

, Stiles

M.C.

; Trabectome Study Group. Ab interno trabeculectomy: outcomes in exfoliation versus primary open-angle glaucoma. J Cataract Refract Surg 2012; 38: 315–23.