The Efficacy of Phacotrabeculectomy in Reducing Intraocular Pressure

Authors

  • Zahir Khan Khalil Rehman Medical College Peshawar, Pakistan
  • Shafqat Ali Shah Bacha Khan Medical College, Mardan, Pakistan
  • Amir Naseem Saidu Medical College, Swat, Pakistan
  • Saman Mudassir Hayatabad Medical Complex, Peshawar, Pakistan
  • Asif Mehmood Orakzai Rehman Medical College Peshawar. Pakistan.

DOI:

https://doi.org/10.52206/jsmc.2024.14.2.809

Abstract

Background: Primary open angle glaucoma and age related cataract are ocular comorbidities which can occur in some individuals at different times. Phacoemulsification is carried out for restoration of vision decreased by cataract while trabeculectomy is a procedure to decrease the intra ocular pressure. To save the time, money and stay in the hospital, phacotrabeculectomy is a single procedure which can fulfill both the restoration of vision and decrease intraocular pressure.
Objectives: To determine the efficacy of phacotrabeculectomy in decreasing the intraocular pressure in patients having both primary open angle glaucoma and age related cataract.
Materials and Methods: This study was conducted at the Eye department, Hayatabad Medical Complex, Peshawar, from 1st August, 2022 to 1st February 2023 after getting the permission from Ethical Committee to do this study. Patients both males and females, from 40-80 years of age, who had coexisting age related cataract (ARC) and Primary open angle glaucoma (POAG), whose intraocular pressures (IOP) was 21mm Hg or above, with and without using anti-glaucoma treatment.
Patients who had secondary or rosette shaped cataract, past ocular trauma (including ocular surgery along with its intraoperative or post-operative complications) and trauma after phacotrabeculectomy procedure during the follow up period were excluded from this study.
Results: All 121 patients underwent Phacotrabeculectomy. Follow up was done for 5 months. Preoperative mean intraocular pressure (IOP) was 23.53 ± 4.22SD which reduced to 12.90 ± 2.09SD postoperatively which was highly significant with p- value=0.001
Conclusion: Phacotrabeculectomy reduced Intraocular pressure by >10 mm Hg in our study which showed that this procedure is very effective in coexisting age related cataract and primary open angle glaucoma.
Keywords: Age related cataract, Angle closure glaucoma, Combined phaco-trabeculectomy, Glaucoma, Intraocular pressure, Open angle glaucoma, Trabeculectomy.

Author Biographies

Zahir Khan Khalil, Rehman Medical College Peshawar, Pakistan

Assistant Professor of Pediatric Ophthalmology at Rehman Medical College, Peshawar, Pakistan

Amir Naseem, Saidu Medical College, Swat, Pakistan

Assistant Professor of Ophthalmology, Saidu Medical College. Swat, Pakistan

Saman Mudassir, Hayatabad Medical Complex, Peshawar, Pakistan

Specialist Registrar, Department of Gynae and Obs HMC Peshawar, Pakistan.

Asif Mehmood Orakzai, Rehman Medical College Peshawar. Pakistan.

Assistant Professor of Ophthalmology, Rehman Medical College, Peshawar, Pakistan.

References

Cook C, Foster P. Epidemiology of Glaucoma: what's new? Can J Opthalmol 2012;(47):223-6. DOI: https://doi.org/10.1016/j.jcjo.2012.02.003

Rao GN, Khanna R, Payal A. The global burden of cataract. Current Opin Ophthalmol 2011;(22):4-9. DOI: https://doi.org/10.1097/ICU.0b013e3283414fc8

Tham YC, Li X, Wong TY, Quigley HA, Aung T, Cheng Chin-Yu. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology 2014;121(11):2081-90. DOI: https://doi.org/10.1016/j.ophtha.2014.05.013

Mansberger SL, Gordon MO, Jampel H, Bhorade A, Brandt JD, Wilson B, et al. Reduction in intraocular pressure after cataract extraction: The Ocular Hypertension Treatment Study. Ophthalmology 2012;119(9):1826-31. DOI: https://doi.org/10.1016/j.ophtha.2012.02.050

Andini El A, Avianty A, Herman H, Choliq A. Efficacy and Safety of Manual Small-Incision Cataract Surgery With Trabeculectomy Versus Phacotrabeculectomy in Patients With Glaucoma and Cataract: A Systematic Review and Meta-Analysis. Cureus 2023 Dece;15(12):e51025 DOI: https://doi.org/10.7759/cureus.51025

Maheshwari D, Pillai MR, Kanduri S, Nair IJ, Kader MA, Ramakrishnan R. Comparative studyof surgical outcomes of twin-site phacotrabeculectomy with mitomycin C in primary open-angle glaucoma versus primary angle-closure glaucoma. Indian J Ophthalmol 2023;71(11):3528-33. DOI: https://doi.org/10.4103/IJO.IJO_324_23

Kang YS, Sung MS, Heo H, Ji YS, Park SW. Long-term outcomes of prediction error after combined hacoemulsification and trabeculectomy in glaucoma patients. BMC Ophthalmol 2021;21:60. DOI: https://doi.org/10.1186/s 12886-021-01824-7

Kumar M, Parveen S, Chauhan L. Midterm outcome of single scleral suture technique in trabeculectomy and phacotrabeculectomy: a simplified approach. Ther Adv ophthalmol 2019;11: 2515841419854829. DOI: https://doi.org/10.1177/2515841419854829

Cochran W G. Sampling techniques. 3rd ed 1977. John Wiley & Sons, New York.

Lam D, Wechsler DZ. Five-Year Outcomes of Trabeculectomy and Phacotrabeculectomy. Cereus 2021 Jan;13(1): e12950. DOI: https://doi.org/10.7759/cereus.12950

Ahmadzadaeh A, Kessel L, Subhi Y, Bach-Holm D. Comparative Efficacy of Phacotrabeculectomy versus Trabeculectomy with or without Later Phacoemulsification: A Systematic Review with Meta-Analyses. J Ophthalmol 2021;2021:6682534. DOI: https://doi.org/10.1155/2021/6682534

Senthil S, Rao HL, Choudhari N, garudadri C. Phacoemulsification vs Phacotrabeculectomy in medically controlled angle closure glaucoma with cataract in indian cohort: a randomized control trial. Int Ophthalmol 2022;42:35-45. DOI: https://doi.org/10.1007/s10792-021-01997-6

Universade PA, Komaratih E, Kencono WCD. Comparing phacoemulsification and phacotrabeculectomy for managing primary angle-closure glaucoma with cataracts: a review. Bali Med J 12(3):3001-3006. DOI: https://doi.org/10.15562/bmj.v12i3.4835

Winuntamalakul Y, Chansangpetch S, Retanawongphaibu K, Itthipanichpong R, Manassakorn A, Tantisevi V, et al. Two-Year Outcomes of Trabeculectomy and Phacotrabeculectomy in Primary Open Angle Versus Primary Angle Closure Glaucoma. J Glaucoma 2023 May 1;32(5):374-381. DOI: https://doi.org/10.1097/IJG.0000000000002172

Additional Files

Published

21-04-2024

How to Cite

1.
Zahir Khan Khalil, Shafqat Ali Shah, Amir Naseem, Saman Mudassir, Asif Mehmood Orakzai. The Efficacy of Phacotrabeculectomy in Reducing Intraocular Pressure . J Saidu Med Coll Swat [Internet]. 2024 Apr. 21 [cited 2024 Jun. 13];14(2):70-3. Available from: https://jsmc.pk/index.php/jsmc/article/view/809

Most read articles by the same author(s)