Viscocanalostomy and phacoviscocanalostomy: long-term results.
OBJECTIVE
To determine the safety and efficacy of viscocanalostomy and cataract extraction by phacoemulsification combined with viscocanalostomy (phacoviscocanalostomy) in the management of medically uncontrolled glaucoma.


METHODS
Department of Ophthalmic Surgery, Warrington Hospital, Warrington, England.


METHODS
This prospective nonrandomized study comprised 101 consecutive eyes of 73 patients with medically uncontrolled glaucoma having viscocanalostomy or phacoviscocanalostomy. Outcomes measured were intraocular pressure (IOP) control, visual acuity, gonioscopy, bleb morphology, and complications associated with surgery. Examinations were performed preoperatively and 1 and 7 days and 1, 3, 6, 9, and 12 months postoperatively and then at 6-month intervals. The mean follow-up was 23.9 months +/- 11 (SD) (range 6 months to 3.5 years).


RESULTS
The mean preoperative IOP was 24.9 +/- 5.7 mm Hg on 2.27 +/- 0.8 medications and the mean postoperative IOP at last follow-up, 16.14 +/- 2.9 mm Hg on 0.1 medications. A postoperative IOP of 21 mm Hg or less was achieved in 93% of eyes. In the remaining 7%, an addition of a mean of 1.4 medications achieved an IOP less than 21 mm Hg. No case required further glaucoma surgery. The mean percentage of IOP reduction in eyes having viscocanalostomy alone was 37% and in eyes having phacoviscocanalostomy, 33%. Complications were minor and included 4 small hyphemas, 5 small choroidal detachments, 1 iris prolapse through the phaco incision, and 10 intraoperative microperforations of the trabeculo-Descemet's window. Transient postoperative pressure elevations secondary to topical steroids occurred in 18% of eyes.


CONCLUSIONS
Viscocanalostomy and phacoviscocanalostomy were safe and effective in the surgical management of glaucoma and combined glaucoma and cataract. There was a low incidence of complications postoperatively and throughout the long-term follow-up.
Wishart
Manjieh S
MS
Department of Ophthalmic Surgery, Warrington Hospital, Warrington, Cheshire, United Kingdom.
Shergill
Tejpal
T
Porooshani
Hamid
H
D000368:Aged; D000369:Aged, 80 and over; D019923:Capsulorhexis; D002386:Cataract / Q000150:complications / Q000628:therapy; D005260:Female; D018463:Filtering Surgery / Q000379:methods*; D005902:Glaucoma, Open-Angle / Q000150:complications / Q000601:surgery*; D006068:Gonioscopy; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification / Q000379:methods*; D011183:Postoperative Complications; D011446:Prospective Studies; D012449:Safety; D013524:Surgical Flaps; D016896:Treatment Outcome; D014792:Visual Acuity