Cataract surgery in patients with end-stage glaucoma

Poster Details

First Author: T.Gracner SLOVENIA

Co Author(s):    D. Pahor              

Abstract Details

Purpose:

To evaluate the outcome of phacoemulsification and intraocular lens implantation (PHACO IOL) in eyes with end-stage glaucoma.

Setting:

Department of Ophthalmology, University Clinical Centre Maribor, Maribor, Slovenia

Methods:

Eighteen eyes of 18 consecutive patients with coexisting cataract and different forms of end-stage glaucoma with a cup-disc ratio (C/D) of 1.0 and severe visual field (VF) defects with partially preserved central function in which PHACO IOL was done were included in this prospective clinical study. All patients had advanced glaucomatous VF loss according to the Hodapp classification on automated static perimetry, or an extensive ring-shaped or half-ring-shaped absolute defect in the paracentral VF area with a central island, stage IV according to the Aulhorn classification on Goldmann perimetry. The indications for PHACO IOL included a best corrected visual acuity (BCVA) of 0.3 logMAR (0.5 decimal equivalents of Snellen’s visual acuity) or worse with visual disturbance caused by the cataract. Intraocular pressure (IOP) was measured before and one week, one, 3, 6, and 12 months after PHACO IOL. The BCVA, the number of antiglaucoma medications and the VF test results before PHACO IOL and at the end of follow-up were evaluated.

Results:

The follow-up period after PHACO IOL was 12 months in all eyes. The mean IOP before surgery was 13.5 mmHg (SD 2.6). There were no differences between the mean IOP before and after surgery during the entire follow-up period (p>0.05). The mean preoperative BCVA was 0.65 (SD 0.3) logMAR (0.25 with a range of 0.05-0.5 decimal equivalents of Snellen’s visual acuity), improving to a mean of 0.19 (SD 0.1) logMAR postoperatively (0.67 with a range of 0.3-1.0 decimal equivalents of Snellen’s visual acuity) at the end of 12 months of follow-up (p<0.0001). The mean number of antiglaucoma medications before surgery was 1.8 (SD 1.4) and 2.0 (SD 1.3) postoperatively at the end of 12 months of follow-up (p=0.104). Preoperatively the mean value of the mean deviation in 7 eyes on automated perimetry was -23.57 dB (SD 3.9) and -22.87 dB (SD 4.1) postoperatively at the end of 12 months of follow-up (p=0.105). Preoperatively the mean VF island in 11 eyes on Goldmann perimetry was 17.0° (SD 7.2), improving to 20.4° (SD 9.0) postoperatively at the end of 12 months of follow-up (p=0.033).

Conclusions:

PHACO IOL in eyes with coexisting cataract end-stage glaucoma resulted in a stable IOP and a significantly improved BCVA without worsening of the VF. So patients with progressive cataract and end-stage glaucoma can benefit from cataract surgery. FINANCIAL DISCLOSURE?: No