Outcomes of combined phacoemulsification and deep sclerectomy: a 10-year UK single-centre study.
OBJECTIVE
To report the outcomes of combined phacoemulsification and -deep sclerectomy (phaco-DS) from a single UK centre over a 10-year period.


METHODS
Retrospective analysis of phaco-DS data extracted from an ongoing glaucoma surgery database within Calderdale and Huddersfield NHS Trust. Two hundred and ninety-six eyes of 282 patients were included. Data included patient demographics, pre- and postoperative intraocular pressure (IOP), use of mitomycin C (MMC), spacer device implantation, and follow-up details including surgical success rates. IOP success criteria were: (A) IOP <19 mm Hg and/or 20% decrease from baseline and (B) IOP <16 mm Hg and/or 30% drop from baseline.


RESULTS
Mean follow-up was 63.5 ± 35.3 months. MMC was applied in 145 eyes (49%). Kaplan-Meier success rates in all eyes for criteria A were 89.1% and 80% with glaucoma medications (qualified success) and 81.2% and 68.3% without medications (unqualified success) at 2 and 5 years, respectively. Qualified success for criteria B was 72.4 and 61.4% and unqualified rates were 67.2 and 55.2% for the same time periods. Repeated-measures ANOVA showed significantly lower IOP in the phaco-DS with MMC group up to 3 years postoperatively (P = 0.002). Cox's proportional hazards for criteria B, however, showed no significant effect of MMC application in the long term (P = 0.2). Increasing age and laser goniopuncture were positively associated with success, whereas the absence of spacer devices was negatively associated. At last follow-up, 20% of eyes were on glaucoma medications. Complication rates were low with hypotony rates of 0.68%.


CONCLUSIONS
This study confirms the long-term safety and efficacy of phaco-DS as a primary glaucoma procedure.
Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK.
K
K
Mercieca
Calderdale and Huddersfield NHS Trust, Huddersfield, UK.
B
B
Shevade
Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK.|Calderdale and Huddersfield NHS Trust, Huddersfield, UK.
N
N
Anand
D000368:Aged; D000369:Aged, 80 and over; D000477:Alkylating Agents / Q000008:administration & dosage; D002386:Cataract / Q000150:complications*; D005260:Female; D005901:Glaucoma / Q000150:complications* / Q000601:surgery; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D016685:Mitomycin / Q000008:administration & dosage; D018918:Phacoemulsification / Q000706:statistics & numerical data*; D011183:Postoperative Complications; D011677:Punctures; D012189:Retrospective Studies; D012599:Sclerostomy / Q000706:statistics & numerical data*; D006113:United Kingdom; D014792:Visual Acuity / Q000502:physiology
D000477:Alkylating Agents; D016685:Mitomycin