Does the adjunctive peeling of juxtacanalicular tissue affect the outcome of two-site phaco-viscocanalostomy?
OBJECTIVE
To compare the surgical outcomes of combined corneal-incision cataract surgery and viscocanalostomy (phaco-VCS) with or without the adjunctive peeling of juxtacanalicular tissue (JCT) in 136 patients of open-angle glaucoma or ocular hypertension.


METHODS
In a prospective clinical trial, 63 eyes underwent phaco-VCS (Peeling (-) group), and 73 eyes underwent phaco-VCS with the peeling of JCT (Peeling (+) group). The postoperative IOP, the probability of successful IOP reduction without medications, and postoperative complications were compared between the two groups.


RESULTS
The mean preoperative IOP of 19.9 +/- 3.3 (+/-SD) mm Hg in the Peeling (-) group decreased significantly to 13.9 +/- 6.8 at 3 days, 14.6 +/- 3.1 at 12 months, and 15.5 +/- 2.3 mm Hg at 24 months. The IOP of 20.2 +/- 3.2 mm Hg in the Peeling (+) group decreased significantly to 11.4 +/- 5.1 at 3 days, 14.9 +/- 3.0 at 12 months, and 15.9 +/- 2.1 mm Hg at 24 months. There was no significant difference in IOP levels between the two groups (P >/= 0.1512) except for the IOP level at 3 postoperative days (P = 0.0265). The probabilities of achieving IOPs without medications under 21 mm Hg and 15 mm Hg at 24 months in the Peeling (-) groups were 61.0% and 10.4%, and those in the Peeling (+) group were 61.7% and 23.9% (P >/= 0.4389). The incidences of IOP spike more than 30 mm Hg (7.9%) and fibrin formation (15.8%) in the Peeling (-) group were higher than in the Peeling (+) group (0%; P = 0.0195, 5.5%; P = 0.1907). Slit-lamp microscopic hyphema, which included red blood cells in the anterior chamber was observed in about half, and bleb formation more than 1 month was less than 5% in both groups.


CONCLUSIONS
Postoperative IOPs were significantly decreased in both groups. Although the peeling of JCT was not enhanced in long-term reduction of the IOP, it lowered IOP at postoperative 3 days and the incidence of IOP spike. The adjunctive procedure would be beneficial to glaucoma patients in phaco-VCS.
Park
Masami
M
Sensho-kai Eye Institute, Kyoto, Japan. mpark@belle.shiga-med.ac.jp
Tanito
Masaki
M
Takahashi
Hirokazu
H
Chihara
Etsuo
E
D000368:Aged; D000369:Aged, 80 and over; D003238:Connective Tissue / Q000601:surgery; D005260:Female; D018463:Filtering Surgery / Q000379:methods*; D005902:Glaucoma, Open-Angle / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D009798:Ocular Hypertension / Q000601:surgery; D018918:Phacoemulsification / Q000379:methods*; D011446:Prospective Studies; D012449:Safety; D012599:Sclerostomy; D013524:Surgical Flaps; D014129:Trabecular Meshwork / Q000601:surgery*; D016896:Treatment Outcome