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Comparison of 2-year-results of mitomycin C-augmented trabeculectomy with or without cataract extraction in glaucoma patients

Published:October 19, 2018DOI:https://doi.org/10.1016/j.jcjo.2018.07.006

      Abstract

      Purpose

      Comparison of the 2-year results of phacotrabeculectomy (CET) and trabeculectomy (TE), both augmented with mitomycin C.

      Methods

      This prospective study enclosed 246 eyes in 246 consecutive patients that had undergone trabeculectomy (n = 85) or phacotrabeculectomy (n = 161, hereof n = 10 phacoretrabeculectomy) augmented by mitomycin C. Endpoints were best corrected visual acuity (BCVA), intraocular pressure (IOP), and number of antiglaucomatous medications at baseline, 3 months, and 2 years postoperatively. Postoperative management involved local steroid application and laser suture lysis according to a standardized protocol.

      Results

      Both interventions reduced IOP statistically significant and stable. In the phacotrabeculectomy group BCVA improved from 0.45 ± 0.47 logMAR units preoperatively to 0.28 ± 0.54 logMAR units at 2 years (p < 0.001) and remained unchanged in the trabeculectomy group. After 2 years IOP reduced from 22.5 ± 7.2 mm Hg preoperatively to 11.5 ± 3.1 mm Hg in the TE group and from 20.0 ± 5.4 mm Hg to 12.5 ± 4.8 mm Hg in the CET group (both p > 0.05). The mean number of antiglaucomatous medications was significantly reduced from 2 ± 1 in both groups to 0.3 in the trabeculectomy group and to 0.4 in the phacotrabeculectomy group. With this standardized surgical procedure and postoperative protocol, there was no need for local postoperative antimetabolites. No Tenon's capsule cysts developed. In the subgroup of patients with phacoretrabeculectomy BCVA and IOP improvements were comparable to the phacotrabeculectomy group outcomes.

      Conclusions

      Phacotrabeculectomy is comparably as effective as trabeculectomy alone in reducing IOP and the need for antiglaucomatous medication over a time interval of 2 years. We found indications that this favourable therapeutic effect is also true for patients needing phacoretrabeculectomy treatment.

      Résumé

      Objectif

      Comparer les résultats à 2 ans de la phacotrabéculectomie et de la trabéculectomie, avec adjonction de mitomycine C dans les 2 cas.

      Méthodes

      Cette étude prospective regroupait 246 yeux de 246 patients consécutifs qui avaient subi une trabéculectomie (n = 85) ou une phacotrabéculectomie (n = 161, dont 10 cas de phaco-retrabéculectomie) avec adjonction de mitomycine C. Les paramètres de mesure étaient les suivants : meilleure acuité visuelle corrigée (MAVC), pression intraoculaire (PIO) et nombre d'antiglaucomateux au départ ainsi que 3 mois et 2 ans après l'intervention. La prise en charge postopératoire comprenait l'application locale de stéroïde et la lyse de suture au laser, conformément à un protocole standardisé.

      Résultats

      Les deux types d'interventions ont permis une baisse stable et statistiquement significative de la PIO. Dans le groupe phacotrabéculectomie, la MAVC est passée de 0,45 ± 0,47 logMAR avant l'intervention à 0,28 ± 0,54 logMAR après 2 ans (p < 0,001) et est demeurée la même dans le groupe trabéculectomie. La PIO est passée de 22,5 ± 7,2 mm Hg avant l'intervention à 11,5 ± 3,1 mm Hg après 2 ans dans le groupe trabéculectomie et de 20,0 ± 5,4 mm Hg à 12,5 ± 4,8 mm Hg dans le groupe phacotrabéculectomie (p > 0,05 dans les 2 cas). Le nombre moyen d'antiglaucomateux a diminué significativement, passant de 2 ± 1 dans les 2 groupes à 0,3 dans le groupe trabéculectomie et à 0,4 dans le groupe phacotrabéculectomie. Grâce à cette procédure chirurgicale standardisée et au protocole postopératoire, aucun patient n'a eu besoin d'antimétabolites locaux en période postopératoire. De plus, il ne s'est produit aucun kyste de la capsule de Tenon. Dans le sous-groupe de patients ayant subi une phaco-retrabéculectomie, les améliorations de la MAVC et de la PIO étaient comparables aux résultats obtenus dans le groupe phacotrabéculectomie.

      Conclusions

      La phacotrabéculectomie offre une efficacité comparable à celle de la trabéculectomie seule pour ce qui est de la réduction de la PIO et de l'administration d'antiglaucomateux sur une période de 2 ans. Selon nos observations, il en est de même pour les patients qui doivent subir une phaco-retrabéculectomie.
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