Advanced nonpenetrating trabeculectomy (advanced NPT) and combined surgery of advanced NPT and phacoemulsification and intraocular lens implantation.
We have devised a new glaucoma surgery combining deep sclerectomy with nonpenetrating trabeculectomy (NPT); we call this surgery advanced NPT. We evaluated intraocular pressure (IOP) control, postoperative complication and visual acuity after combined advanced NPT and phacoemulsification and intraocular lens implantation (combined surgery), and advanced NPT alone. The mean preoperative IOP for the trabeculectomy only group was 22.4 +/- 6.3 mmHg(bleb+), 23.0 +/- 4.9 mmHg(bleb-), and that of the combined surgery group was 18.1 +/- 4.5 mmHg(bleb+), 18.5 +/- 2.6 mmHg(bleb-). Mean postoperative IOP for the two groups were 13.0 +/- 2.3 mmHg(bleb+), 15.0 +/- 1.5 mmHg(bleb-) and 12.9 +/- 2.7 mmHg(bleb+), 13.3 +/- 2.4 mmHg(bleb-), respectively. After 15 months, the success probability for postoperative IOP control were 63%(bleb+), 23%(bleb-) in the advanced NPT only group (<or=12 mmHg), and 60% in the advanced NPT only group, 70% in the combined surgery group (<or=14 mmHg) (Kaplan-Meier survival rate). In early complication, there were significantly fewer cases of shallow anterior chamber, hypertension, hypotension and anterior chamber inflamation in both groups than that of trabeculectomy. Nd:YAG goniopuncture was performed for purposes of better IOP control; preferred performance being within a month after surgery. Regarding visual acuity after either advanced NPT alone or combined surgery, an earlier recovery can be expected than with trabeculectomy. Advanced NPT and combined procedure is a reliable technique for glaucoma and cataract surgery.
Kuroda
S
S
Nagata Eye Clinic, Nara City, Nara, Japan.
Mizoguchi
T
T
Terauchi
H
H
Nagata
M
M
D000368:Aged; D002386:Cataract / Q000150:complications*; D003228:Conjunctiva / Q000601:surgery; D005500:Follow-Up Studies; D005901:Glaucoma / Q000150:complications* / Q000601:surgery; D006801:Humans; D007429:Intraocular Pressure; D019654:Lens Implantation, Intraocular / Q000379:methods*; D008875:Middle Aged; D018918:Phacoemulsification / Q000379:methods*; D013524:Surgical Flaps; D014130:Trabeculectomy / Q000379:methods*; D016896:Treatment Outcome; D014792:Visual Acuity