Journal of Current Glaucoma Practice

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VOLUME 10 , ISSUE 1 ( January-April, 2016 ) > List of Articles

REVIEW ARTICLE

The Safety and Efficacy of Two-site Phacotrabeculectomy with Mitomycin C under Retrobulbar and Topical Anesthesia

Raquel Rodriguez, Rachel Alburquerque, Tripper Sauer, Juan Francisco Batlle

Keywords : Anesthesia, Mitomycin C, Phacotrabeculectomy, Topical, Trabeculectomy

Citation Information : Rodriguez R, Alburquerque R, Sauer T, Batlle JF. The Safety and Efficacy of Two-site Phacotrabeculectomy with Mitomycin C under Retrobulbar and Topical Anesthesia. J Curr Glaucoma Pract 2016; 10 (1):7-12.

DOI: 10.5005/jp-journals-10008-1196

License: CC BY-NC 4.0

Published Online: 01-08-2019

Copyright Statement:  Copyright © 2016; The Author(s).


Abstract

Purpose: To evaluate and compare the safety and efficacy of combined two-site phacoemulsification and trabeculectomy surgery with mitomycin C (MMC) in glaucoma-cataract patients with retrobulbar or topical anesthesia. Patients and methods: A retrospective, nonrandomized review of consecutive phacotrabeculectomy patients with a minimum follow-up time of 6 months, no previous glaucoma surgeries, and a preoperative visual acuity (VA) greater than light perception. The main outcome measures were preoperative and postoperative VA, intraocular pressure (IOP), use of glaucoma medications, and complications. A complete surgical success required an IOP from 6 to 18 mm Hg, no visually devastating complications, no return to surgery, and no use of glaucoma medications. Qualified success allowed the use of up to two glaucoma medications. Anesthesia groups were compared by student t-tests and log rank comparison of Kaplan-Meier survival rates. Results: Eighty-seven eyes (83 patients) met inclusion criteria, with a mean follow-up of 19 ± 12 months (6-57 months). The average eye gained 3.1 ± 4.9 lines of VA, lost 4.0 ± 7.1 mm Hg of IOP, and decreased 1.0 ± 1.3 glaucoma medications. Retrobulbar and topical anesthesia groups had statistically equivalent mean changes in VA (p = 0.910), IOP (p = 0.268), and use of glaucoma medications (p = 0.964). Postoperative complication rates were also statistically similar (p = 0.580). Complete success was greater in the retrobulbar group (p = 0.006), however, qualified success was equivalent in both groups (p = 0.769). Conclusion: Two-site phacotrabeculectomy with MMC in West Indian patients is as safe and effective for glaucoma-cataract patients with topical anesthesia as it is under retrobulbar anesthesia, and without short-term losses in VA and the chance of serious complications from injection.


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  1. Veldman E, Greve EL. Glaucoma filtering surgery, a retrospective study of 300 operations. Doc Ophthalmol 1987;67(1-2):151-170.
  2. Wishart PK, Austin MW. Combined cataract extraction and trabeculectomy: phacoemulsification compared with extracapsular technique. Ophthalmic Surg 1993;24(12): 814-821.
  3. Casson RJ, Salmon JF. Combined surgery in the treatment of patients with cataract and primary open-angle glaucoma. J Cataract Refract Surg 2001;27(11):1854-1863.
  4. Jamarillo J. Efectividad de la Facotrabeculectomía en patientes con cataratas y glaucoma. Presented at Vision 2020 conference. Baranquilla, Columbia, 2006.
  5. Friedman DS, Jampel HD, Lubomski LH, et al. Surgical strategies for coexisting glaucoma and cataract: an evidencebased update. Ophthalmology 2002;109(10):1902-1913.
  6. Pohjalainen T, Vesti E, Uusitalo R, Laatikainen L. Phacoemulsification and intraocular lens implantation in eyes with open-angle glaucoma. Acta Ophthalmol Scand 2001;79(3): 313-316.
  7. Verges C, Cazal J, Lavin C. Surgical strategies in patients with cataract and glaucoma. Curr Opin Ophthalmol 2005;16(1): 44-52.
  8. Murthy SK, Damji KF, Pan Y, Hodge WG. Trabeculectomy and phacotrabeculectomy, with mitomycin-C, show similar 2-year target IOP outcomes. Can J Ophthalmol 2006;41(1): 51-59.
  9. Stark WJ, Goyal RK, Awad O, et al. The safety and efficacy of combined phacoemulsification and trabeculectomy with releasable sutures. Br J Ophthalmol 2006;90(2):146-149.
  10. Shingleton BJ, Price RS, O'Donoghue MW, Goyal S. Comparison of 1-site versus 2-site phacotrabeculectomy. J Cataract Refract Surg 2006;32(5):799-802.
  11. Cagini C, Murdolo P, Gallai R. Long-term results of one-site phacotrabeculectomy. Acta Ophthalmol Scand 2003;81(3): 233-236.
  12. Shin DH, Hughes BA, Song MS, et al. Primary glaucoma triple procedure with or without adjunctive mitomycin. Prognostic factors for filtration failure. Ophthalmol 1996;103(11): 1925-1933.
  13. DeBry PW, Perkins TW, Heatley G, et al. Incidence of lateonset bleb-related complications following trabeculectomy with mitomycin. Arch Ophthalmol 2002;120(3):297-300.
  14. Lai JS, Tham CC, Lam DS. Topical anesthesia in phacotrabeculectomy. J Glaucoma 2002;11(3):271-274.
  15. Ahmed II, Zabriskie NA, Crandall AS, et al. Topical versus retrobulbar anesthesia for combined phacotrabeculectomy: prospective randomized study. J Cataract Refract Surg 2002;28(4):631-638.
  16. Zabriskie NA, Ahmed II, Crandall AS, et al. A comparison of topical and retrobulbar anesthesia for trabeculectomy. J Glaucoma 2002;11(4):306-314.
  17. Pablo LE, Ferreras A, Perez-Olivan S, et al. Contact-topical plus intracameral lidocaine versus peribulbar anesthesia in combined surgery: a randomized clinical trial. J Glaucoma 2004;13(6):510-515.
  18. Lai JS, Tham CC, Lam DS. Topical anesthesia in phacotrabeculectomy. J Glaucoma 2002 Jun;11(3):271-274.
  19. Krupin T, Feitl ME, Bishop KI. Postoperative intraocular pressure rise in open-angle glaucoma patients after cataract or combined cataract-filtration surgery. Ophthalmol 1989; 96(5):579-584.
  20. Jampel HD, Friedman DS, Lubomski LH, et al. Effect of technique on intraocular pressure after combined cataract and glaucoma surgery: an evidence-based review. Ophthalmol 2002;109(12):2215-2224.
  21. Shin DH, Kim YY, Sheth N, et al. The role of adjunctive mitomycin C in secondary glaucoma triple procedure as compared to primary glaucoma triple procedure. Ophthalmol 1998;105(4):740-745.
  22. Patel BC, Burns TA, Crandall A, et al. A comparison of topical and retrobulbar anesthesia for cataract surgery. Ophthalmol 1996;103(8):1196-1203.
  23. Vass C, Menapace R. Surgical strategies in patients with combined cataract and glaucoma. Curr Opin Ophthalmol 2004;15(1):61-66.
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