Cutting Edge Glaucoma - Issue 2

CATARACT SURGERY IN PATIENTS WITH GLAUCOMA DRAINAGE IMPLANTS: THE HOOKED TUBE TECHNIQUE • 5  ( P = 0.377). There was a statistically significant drop in IOP at 1 month ( P = 0.007), 3 months ( P = 0.043), 1 year ( P = 0.035), but not at the 6-month follow-up ( P = 0.159) in the treatment group. The decreases from the preoperative IOP at 1, 3, 6, and 12 months postoperatively were not statistically significantly different in the control group ( P = 0.168, P = 0.146, P = 0.703, P = 0.910, respectively). The mean postoperative IOP at 1 month was statistically significantly increased in the control group compared with the treatment group ( P = 0.040, Table 2). The IOP remained within 4 mmHg of the preoperative level in all eyes of the treatment group, but not in the control group during the follow-up visits. Two eyes exhibited IOP spikes of 10 mmHg at 1 month and at 3 month. In addition, IOP was 43 mmHg in one patient on the first postoperative day among controls. In this study, the mean number of preoperative (1.5 ± 1.5) and postoperative antiglaucoma medications (Table 2) was not statistically significantly different in the treatment group at any follow-up. However, the number of antiglaucoma medications at 3 and 6 months was significantly greater than before phacoemulsification in the control group (1.4 ± 1.1 vs. 1.7 ± 1.1; P = 0.041, 1.4 ± 1.1 vs. 2.3 ± 1.2; P = 0.017, respectively). After cataract surgery, there was a significant increase in the mean number of antiglaucoma medications used at 6 months in the control group compared with the treatment group ( P = 0.049, Table 2). The Snellen visual acuity improved in 14 (82%) of 17 eyes of treatment group and in 13 (87%) of 15 eyes in control group. At the last follow-up visit, the mean logMAR visual acuity did not differ statistically significantly between the control group and the treatment group (0.2 ± 0.2 vs. 0.3 ± 0.3; P = 0.161). Vision was decreased due to corneal decompensation in one patient in both study groups. The other reason for the decrease in visual acuity was age-related macular degenera- tion. No intraoperative complications were present in any study eyes. Table 2: Postoperative mean intraocular pressure and mean numbers of antiglaucoma medication. Time IOP (mmHg) No. of medications Control group Treatment group P Control group Treatment group P Day 1 17.7 ± 8.1 16.4 ± 2.8 0.551 1.4 ± 1.1 1.4 ± 1.5 0.920 1 month 17.7 ± 4.9 14.4 ± 3.9 0.040 1.5 ± 1.1 1.2 ± 1.3 0.496 3 months 17.7 ± 4.9 15.9 ± 4.1 0.250 1.7 ± 1.1 1.1 ± 1.4 0.560 6 months 16.1 ± 2.6 16.1 ± 4.7 0.957 2.3 ± 1.2 1.4 ± 1.5 0.049 12 months 15.9 ± 2.4 15.8 ± 4.9 0.925 1.7 ± 1.0 1.4 ± 1.2 0.418 Treatment the hooked tube technique, IOP intraocular pressure Conclusions Cataract progression has been reported to increase after GDI surgery [6]. Although the IOP spike is a rather rare complication after GDI surgery, it is not insignificant especially in the advanced glaucoma eyes. For the historical comparison, three studies were reviewed on phacoemulsification