Abstract
Purpose
To estimate the incidence and predisposing factors for cataract extraction (CE) after Deep Sclerectomy (DS) with Mitomycin-C (MMC) and its effect on intraocular pressure (IOP) control.
Methods:
Retrospective study of phakic eyes which had DS with MMC performed over a 5-year period. 179 eyes of 179 patients were included.
Results
Mean age at time of DS was 68.6 ± 9.7 years and mean follow-up was 89.4 ± 29.4 months. 63 eyes had CE and the probability of CE following DS was 0% at 1, 11.6% at 3, 21.0% at 5 and 33.2% at 7 years, with a 50% probability (median survival time) of 10 years. Age was association with increased risk for CE (Hazard ratio 1.05, 95% CI: 1.03–1.08, p < 0.0001). Mean IOP had increased from 11 mmHg to 15 mmHg in the first 3 months and remained higher up to a year (p < 0.001). There was no difference in the probability of maintaining an IOP < 16 mmHg without additional medications or needle revision (p = 0.05,Log-rank test). 20/47 eyes that failed were from the CE group, of which 14 (22.2%) failed prior to CE. Number of eyes on glaucoma medications before CE was 6 (mean edications 0.2 ± 0.5 m) and by last follow-up, 9 eyes were on medications (mean medications 0.2 ± 0.7). Post-CE needle revision was performed on 4 eyes.
Conclusions
The probability of CE after DS is low, with a gradual increase with time. Increasing age was found to be a statistically significant risk factor. There was a modest increase in IOP after CE and increase use of glaucoma medications.
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References
Anderson DR, Drance SM, Schulzer M. Factors that predict the benefit of lowering intraocular pressure in normal tension glaucoma. Am J Ophthalmol. 2003;136:820–9.
AAGIS (Advanced Glaucoma Intervention Study) Investigators. The Advanced Glaucoma Intervention Study: 8. Risk of cataract formation after trabeculectomy. Arch Ophthalmol. 2001;119:1771–9.
Musch DC, Gillespie BW, Niziol LM, Janz NK, Wren PA, Rockwood EJ, et al. Cataract extraction in the collaborative initial glaucoma treatment study: incidence, risk factors, and the effect of cataract progression and extraction on clinical and quality-of-life outcomes. Arch Ophthalmol. 2006;124:1694–700.
Tornqvist G, Drolsum LK. Trabeculectomies. A long-term study. Acta Ophthalmol (Copenh). 1991;69:450–4.
Wong TT, Khaw PT, Aung T, Foster PJ, Htoon HM, Oen FT, et al. The singapore 5-Fluorouracil trabeculectomy study: effects on intraocular pressure control and disease progression at 3 years. Ophthalmology. 2009;116:175–84.
Palanca-Capistrano AM, Hall J, Cantor LB, Morgan L, Hoop J, WuDunn D. Long-term outcomes of intraoperative 5-fluorouracil versus intraoperative mitomycin C in primary trabeculectomy surgery. Ophthalmology. 2009;116:185–90.
Herman DC, Gordon MO, Beiser JA, Chylack LT Jr., Lamping KA, Schein OD, et al. Topical ocular hypotensive medication and lens opacification: evidence from the ocular hypertension treatment study. Am J Ophthalmol. 2006;142:800–10.
Chandrasekaran S, Cumming RG, Rochtchina E, Mitchell P. Associations between elevated intraocular pressure and glaucoma, use of glaucoma medications, and 5-year incident cataract: the Blue Mountains Eye Study. Ophthalmology. 2006;113:417–24.
Rebolleda G, Munoz-Negrete FJ. Phacoemulsification in eyes with functioning filtering blebs: a prospective study. Ophthalmology. 2002;109:2248–55.
Awai-Kasaoka N, Inoue T, Takihara Y, Kawaguchi A, Inatani M, Ogata-Iwao M, et al. Impact of phacoemulsification on failure of trabeculectomy with mitomycin-C. J Cataract Refract Surg. 2012;38:419–24.
Ehrnrooth P, Lehto I, Puska P, Laatikainen L. Phacoemulsification in trabeculectomized eyes. Acta Ophthalmol Scand. 2005;83:561–6.
Swamynathan K, Capistrano AP, Cantor LB, WuDunn D. Effect of temporal corneal phacoemulsification on intraocular pressure in eyes with prior trabeculectomy with an antimetabolite. Ophthalmology. 2004;111:674–8.
Casson R, Rahman R, Salmon JF. Phacoemulsification with intraocular lens implantation after trabeculectomy. J Glaucoma. 2002;11:429–33.
Konstantopoulos A, Yadegarfar ME, Yadegarfar G, Stinghe A, Macleod A, Jacob A, et al. Deep sclerectomy versus trabeculectomy: a morphological study with anterior segment optical coherence tomography. Br J Ophthalmol. 2013;97:708–14.
Anand N, Pilling R. Nd:YAG laser goniopuncture after deep sclerectomy: outcomes. Acta Ophthalmol. 2010;88:110–5.
Koukkoulli A, Musa F, Anand N. Long-term outcomes of needle revision of failing deep sclerectomy blebs. Graefe’s Arch Clin Exp ophthalmol. 2015;253:99–106.
Anand N, Kumar A, Gupta A. Primary phakic deep sclerectomy augmented with mitomycin C: long-term outcomes. J Glaucoma. 2011;20:21–7.
Rulli E, Biagioli E, Riva I, Gambirasio G, De Simone I, Floriani I, et al. Efficacy and safety of trabeculectomy vs nonpenetrating surgical procedures: a systematic review and meta-analysis. JAMA Ophthalmol. 2013;131:1573–82.
Lachkar Y, Neverauskiene J, Jeanteur-Lunel MN, Gracies H, Berkani M, Ecoffet M, et al. Nonpenetrating deep sclerectomy: a 6-year retrospective study. Eur J Ophthalmol. 2004;14:26–36.
Rho S, Kang SY, Hong S, Seong GJ, Jung JJ, Kim CY. Long-term results of deep sclerectomy with small collagen implant in Korean. Korean J Ophthalmol: Kjo. 2013;27:34–8.
Shaarawy T, Mansouri K, Schnyder C, Ravinet E, Achache F, Mermoud A. Long-term results of deep sclerectomy with collagen implant. J Cataract Refract Surg. 2004;30:1225–31.
Chen PP, Weaver YK, Budenz DL, Feuer WJ, Parrish RK 2nd. Trabeculectomy function after cataract extraction. Ophthalmology. 1998;105:1928–35.
Comparison of glaucomatous progression between untreated patients with normal-tension glaucoma and patients with therapeutically reduced intraocular pressures. Collaborative Normal-Tension Glaucoma Study Group. Am J Ophthalmol. 1998;126:487–97.
Zahid S, Musch DC, Niziol LM, Lichter PR. Risk of endophthalmitis and other long-term complications of trabeculectomy in the Collaborative Initial Glaucoma Treatment Study (CIGTS). Am J Ophthalmol. 2013;155:674–80. 80.e1
Chiou AG, Mermoud A, Jewelewicz DA. Post-operative inflammation following deep sclerectomy with collagen implant versus standard trabeculectomy. Graefe’s Arch Clin Exp ophthalmol. 1998;236:593–6.
Wilkins M, Indar A, Wormald R. Intra-operative mitomycin C for glaucoma surgery. Cochrane Database Syst Rev. 2001:Cd002897.
Kirwan JF, Lockwood AJ, Shah P, Macleod A, Broadway DC, King AJ, et al. Trabeculectomy in the 21st century: a multicenter analysis. Ophthalmology. 2013;120:2532–9.
Crichton AC, Kirker AW. Intraocular pressure and medication control after clear corneal phacoemulsification and AcrySof posterior chamber intraocular lens implantation in patients with filtering blebs. J Glaucoma. 2001;10:38–46.
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Mercieca, K., Perumal, D., Darcy, K. et al. Cataract extraction after deep sclerectomy and its effect on intraocular pressure control. Eye 33, 557–563 (2019). https://doi.org/10.1038/s41433-018-0262-5
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DOI: https://doi.org/10.1038/s41433-018-0262-5
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