title: Refractive outcomes of combined cataract and glaucoma surgery.
abstract: OBJECTIVE
  This study was designed to evaluate the refractive outcomes of combined cataract extraction and glaucoma surgery.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  A retrospective chart review of patients undergoing simultaneous cataract extraction with trabeculectomy or glaucoma drainage device surgery was performed. The main outcome measure evaluated was whether or not spherical equivalent of -1.00 to +0.50 D was achieved at 3 to 6 months postoperatively. Secondary outcomes included: reduction in intraocular pressure, amount of cylinder induced by combined surgery, and individual patient characteristics that may have affected refractive outcome. Outcomes were compared with an age-matched and sex-matched control group of patients who had uncomplicated cataract surgery during the same time period.
  
  
  RESULTS
  Forty-three eyes of 36 patients underwent combined cataract extraction and glaucoma surgery. A refractive outcome of spherical equivalent between -1.00 and +0.50 D was achieved in 32 of 43 eyes (74%) at 3 to 6 months after surgery. Logistic regression analysis found a 1.14 increased risk of the refraction being outside this defined refractive range in older compared with younger patients (by year, 95% CI, 1.04-1.27). Type of lens implant used, type of glaucoma surgery, and preoperative best-corrected visual acuity did not significantly affect refractive outcome. In a subset of 22 eyes with available preoperative keratometry measures, a mean 1.31 D (SD=0.86; range, 0.26 to 3.76) of corneal astigmatism was induced by combined surgery. In comparison, a matched control group who had cataract surgery alone achieved target refractive outcome in 34 of 40 eyes (85%, P=0.001) and had a trend for less induced cylinder (0.99, SD=0.72, P=0.11).
  
  
  CONCLUSIONS
  Favorable refractive outcomes were achieved in the majority of patients despite the potential alteration of preoperative measurements and introduction of error into lens selection when using a combined approach. There does not seem to be a difference in the refractive outcome with regard to the type of glaucoma surgery performed. Control patients who had cataract surgery alone had a higher percentage of achieving target refractive goal and less induced cylinder.
authors.affiliation: *Bascom Palmer Eye Institute, University of Miami Miller School of Medicine ‡Department of Ophthalmology, Miami Veterans Affairs Medical Center, Miami, FL †College of Human Medicine, Michigan State University, Grand Rapids, MI.
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Tzu
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Shah
authors.forename: Anat
authors.initials: A
authors.lastname: Galor
authors.forename: Anna K
authors.initials: AK
authors.lastname: Junk
authors.forename: Ananth
authors.initials: A
authors.lastname: Sastry
authors.forename: Sarah R
authors.initials: SR
authors.lastname: Wellik
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002386:Cataract / Q000150:complications / Q000503:physiopathology; D005260:Female; D005901:Glaucoma / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D020327:Glaucoma Drainage Implants; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification / Q000379:methods*; D019919:Prosthesis Implantation / Q000379:methods*; D012029:Refraction, Ocular / Q000502:physiology*; D012189:Retrospective Studies; D014130:Trabeculectomy / Q000379:methods*; D014792:Visual Acuity / Q000502:physiology