Stratification of phaco-trabectome surgery results using a glaucoma severity index in a retrospective analysis.
BACKGROUND
To stratify the outcomes of phacoemulsification combined with trabectome surgery using a new glaucoma severity index.


METHODS
This is a retrospective, observational cohort study that included open angle glaucoma patients with visually significant cataract that had phacoemulsification combined with trabectome surgery. Exclusion criteria were follow-up less than 12 months, any other surgeries or diagnosis of neovascular or active uveitic glaucoma. Patients were stratified into four groups according to the Glaucoma Index (GI) that incorporated preoperative intraocular pressure (IOP), number of medications and visual field status. The primary outcome measures were IOP reduction and the success rate at 12 months. We examined the relationship between GI group and IOP and medications at one year with a linear regression analysis and survival with log-rank testing.


RESULTS
Of 1374 patients, a total of 498 cases with 12 month follow-up were included in the study after applying the exclusion criteria. At one year, IOP of GI groups 1 through 4 was reduced by 2.9 ± 4.4, 3.6 ± 5.0, 3.9 ± 5.3, and 9.2 ± 7.6 mmHg for. Individuals in the next higher GI group had a 1.69 ± 0.2 mmHg larger IOP decrease. The success rate was 98%, 93%, 96% and 88% at one year for GI groups 1 to 4 (p < 0.05).


CONCLUSIONS
A substantial IOP reduction was seen in subjects with more advanced glaucoma suggesting that the trabecular meshwork is the primary impediment to outflow and its ablation benefits those eyes relatively more than in mild glaucoma. A larger IOP reduction can be expected in individuals with a higher GI group that indicates a clinically more challenging glaucoma.
Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, 15213, PA, USA.
Pritha
P
Roy
Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, 15213, PA, USA.
Ralitsa T
RT
Loewen
Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, 15213, PA, USA.
Yalong
Y
Dang
Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, 15213, PA, USA.|Institute of Ophthalmology and Visual Science, New Jersey Medical School, Newark, 07103, NJ, USA.
Hardik A
HA
Parikh
Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, 15213, PA, USA. Igor.Bussel@gmail.com.
Igor I
II
Bussel
Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, 15213, PA, USA.
Nils A
NA
Loewen
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002386:Cataract / Q000150:complications*; D005260:Female; D005902:Glaucoma, Open-Angle / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014129:Trabecular Meshwork / Q000601:surgery*; D014130:Trabeculectomy / Q000379:methods*; D014794:Visual Fields; D055815:Young Adult
Glaucoma; Microincisional glaucoma surgery; Open-angle; Phacoemulsification; Trabecular meshwork