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      Combined Approach to Phacoemulsification and Trabeculectomy Results in Less Ideal Refractive Outcomes Compared With the Sequential Approach :

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          Abstract

          To compare the refractive outcomes of combined versus sequential trabeculectomy and then phacoemulsification.

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          Most cited references14

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          Population-based glaucoma prevalence studies in Asians.

          Glaucoma-related population-based studies from Japan, Mongolia, India, Singapore, Thailand, China, Bangladesh, Myanmar, Sri Lanka, and South Korea show a higher glaucoma prevalence in Asian patients, including a higher incidence of primary angle-closure glaucoma, than in white patients, although primary open-angle glaucoma (POAG) is still the most commonly reported. Among POAG, normal tension glaucoma predominates over high tension glaucoma, a distinctive finding. Risk factors for glaucoma in population-based studies in both Asian and white patients are similar, except that myopia is a greater risk factor in Asian patients. Diagnostic criteria differ among studies, some using the International Society of Geographic and Epidemiologic Ophthalmology (ISGEO) classification and others not. The devices used to observe the optic disk and test the visual field are also not uniform across studies. Moreover, the ages of patients, and whether rural or urban, were different. To allow reliable comparison of the results of epidemiologic studies, efforts to standardize the diagnostic criteria, devices, and the age range of the study population are required. Copyright © 2014 Elsevier Inc. All rights reserved.
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            Axial length decrease accompanying successful glaucoma filtration surgery.

            To evaluate change in axial length measurement after successful glaucoma filtering surgery. Retrospective consecutive case series. Sixty-two patients with phakia who underwent primary trabeculectomy. The A-scan biometry of ocular axial length before and after trabeculectomy. Changes in ocular axial length measurement after successful trabeculectomy were analyzed. The mean decrease in axial length measurement was 0.423 mm (range, -2.8 to +0.5 mm). Regression analysis yielded a statistically significant association between decrease in axial length measurement and age (P = 0.0001) and post-trabeculectomy intraocular pressure decrease greater than 30 mmHg (P = 0.01). Analysis of variance revealed a significant association between decrease in axial length measurement and use of antimetabolite (P = 0.005). Pseudophakic axial length measurements increased an average of 0.275 mm compared to the axial length after trabeculectomy and before cataract surgery. Axial length measurement decreased in 32 of 62 eyes after successful initial trabeculectomy. A decrease in axial length measurement may have an influence on intraocular lens calculations. Therefore, the authors recommend that an axial length measurement be obtained on phakic eyes before an initial trabeculectomy to reduce the risk of an inaccurate intraocular lens power calculation based on post-trabeculectomy axial length measurements.
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              Phacoemulsification in eyes with functioning filtering blebs: a prospective study.

              To evaluate the effect of phacoemulsification on intraocular pressure (IOP) control in eyes with a previous functioning filtering bleb and no glaucoma medication. Prospective, nonrandomized comparative (self-controlled) trial. Forty-seven patients (49 eyes) who underwent phacoemulsification after successful trabeculectomy, with at least 12 months of follow-up. Clear corneal phacoemulsification and implantation of a foldable intraocular lens in eyes that underwent a previous successful trabeculectomy. The time between both procedures was always greater than 1 year. Preoperative and postoperative IOP, the number of glaucoma medications, bleb appearance, and visual acuity were recorded at each follow-up examination. Success was defined as no need for glaucoma medications, bleb needling, or further glaucoma surgery for IOP control after phacoemulsification. Preoperative and intraoperative factors were evaluated for an association with postoperative failure using Kaplan-Meier survival analysis. The mean (+/- standard deviation) IOP before phacoemulsification was 12.24 (+/- 4.68) mmHg, and it increased 3.94, 3.76, 1.39, 2.04, and 1.57 mmHg on the first postoperative day, after 1, 6, and 12 months, and at the last visit, respectively. At each interval, the mean IOP was significantly higher than the preoperative value (P = 0.000, 0.000, 0.049, 0.01, and 0.01, respectively). Nevertheless, the mean IOP after phacoemulsification was always lower than before trabeculectomy (P = 0.000). At the last visit, glaucoma medication was required in 17 eyes (34.7%). The success rates after phacoemulsification were 83.6%, 68.2%, and 55.7% at 6 months and 1 and 2 years, respectively (Kaplan-Meier survival analysis). The number of glaucoma medications used increased at all follow-up visits (P < 0.005). Bleb size decreased after phacoemulsification (P = 0.000). An IOP before phacoemulsification of greater than 10 mmHg was associated with postoperative failure (P = 0.002). Similarly, bleb failure and the need for glaucoma medication were associated with higher IOPs before phacoemulsification. Phacoemulsification significantly increased IOP and the number of glaucoma medications in eyes with preexisting functioning filtering blebs. Eyes with higher IOPs before phacoemulsification had worsened postoperative IOP control and bleb failure.
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                Author and article information

                Journal
                Journal of Glaucoma
                Journal of Glaucoma
                Ovid Technologies (Wolters Kluwer Health)
                1057-0829
                2016
                October 2016
                : 25
                : 10
                : e873-e878
                Article
                10.1097/IJG.0000000000000489
                27483417
                c0770c46-47e1-4afb-b560-a35e8def0d1f
                © 2016
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