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Phacotrabeculectomy in Eyes With Uveitic Glaucoma

A Retrospective Case-Control Study

Wadke, Vidya DNB*; Lingam, Vijaya MS*; George, Ronnie MS*; George, Amala E. DNB; Ganesh, Sudha K. DO; Biswas, Jyotirmay MS; Balekudaru, Shantha DNB*

doi: 10.1097/IJG.0000000000001276
Original Studies
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Precis: Phacotrabeculectomy with adjunctive mitomycin C is a good option for the management of coexisting cataract and glaucoma. Strict preoperative control of inflammation and close follow-up are essential in the management of eyes with uveitic glaucoma (UG).

Purpose: The purpose of this study was to compare the outcomes of phacotrabeculectomy with adjunctive antimetabolites in the management of patients with UG and patients with primary open-angle glaucoma (POAG).

Materials and Methods: A retrospective case-control study of 112 patients with UG and 120 patients with POAG who underwent phacotrabeculectomy with mitomycin C and had a follow-up of ≥12 months between January 2000 and June 2015 was performed. Patients who had undergone intraocular surgery or cyclodestructive procedures earlier were excluded. The primary outcome was intraocular pressure (IOP) control; secondary outcomes included visual acuity and complication rates.

Results: IOP control was similar at the final visit in the UG group (14.52±6.74 mm Hg) and the POAG group (14.39±4.18 mm Hg) (P=0.867). Kaplan-Meier survival analysis showed a cumulative probability of survival (IOP: 6 to 18 with or without medications) in 71% and 77% at the end of 5 years (P=0.094) in the UG and POAG groups, respectively. Visual outcomes were worse in the UG group (0.5±0.68 logMAR units), as compared with the POAG group (0.27±0.47 logMAR units) (P=0.002). Complications such as cystoid macular edema (P=0.025) and posterior capsular opacification (P=0.004) were more common in the UG group. Recurrence of inflammation occurred in 34 eyes (30.04%) in the UG group.

Conclusion: Meticulous control of perioperative and postoperative inflammation could have contributed to the favorable long-term outcomes of phacotrabeculectomy in UG, as compared with POAG.

*Smt Jadhavabai Nathmal Singhvee Glaucoma Services

Department of Uvea, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India

Disclosure: The authors declare no conflict of interest.

Reprints: Shantha Balekudaru, DNB, Smt Jadhavbai Nathamal Singhvee Glaucoma Services, Medical Research Foundation, Sankara Nethralaya, Old No. 18, New No. 41, College Road, Chennai 600006, Tamil Nadu, India (e-mail: shantha.acharya@gmail.com).

Received November 19, 2018

Accepted April 20, 2019

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