Comparison between the outcomes of combined phaco/trabeculectomy by cataract incision site

PURPOSE: To analyze and compare the main outcomes of two techniques of combined surgery; mitomycin enhanced trabeculectomy combined with phacoemulsification and intraocular lens implantation through a single incision versus a two incisions approach. PATIENTS AND METHODS: The authors retrospectively reviewed one surgeon's consecutive 395 combined phacoemulsification/trabeculectomy surgeries. Patients were divided into two groups, those who underwent phacoemulsification and intraocular lens implantation through one incision (Phaco 1) and the other through two incisions (Phaco 2), both combined with trabeculectomy. Analysis of postoperative visual acuity, intraocular pressure, number of glaucoma medications, postoperative adverse events and additional procedures required, was done. Minimum follow-up was 12 months with an average of 49.2 months. RESULTS: There was a significant difference (p = 0.0237) between the groups in terms of visual acuity improvement rate. By the end of the follow up period, both techniques were equally effective in reducing IOPs by an average of 8.1 mmHg. Postoperative pressure spikes occurred in 9versus 11(p = 0.6838) of the eyes. No significant difference (63Phaco 1 versus 69Phaco 2, p = 0.3230) between the two groups in terms of glaucoma medication reduction was found. There was no significant difference (p = 0.1181), in the total postoperative complications between the two groups (60Phaco 1 vs. 51Phaco 2), as well as in the total number of eyes which required further interventions (60versus 68, p = 0.2223). CONCLUSION: Combined phacoemulsification/ trabeculectomy using either a single or a two site approach, are equally effective in treating glaucoma patients with cataracts.

Comparison of outcomes following combined ECCE-trabeculectomy versus phacoemulsification-trabeculectomy

PURPOSE: To analyze and compare the main outcomes between trabeculectomies combined with extracapsular cataract extraction (ECCE) versus those with phacoemulsification (Phaco). PATIENTS AND METHODS: The authors retrospectively reviewed one surgeon's 357 consecutive cases (475 eyes) of combined cataract extraction, intraocular lens implantation and Mitomycin enhanced trabeculectomy. Patients were divided into two groups, those who underwent extracapsular cataract extraction (80 eyes) and those having phacoemulsification (395 eyes). Analysis of postoperative visual acuity, intraocular pressure (IOP), number of glaucoma medications, postoperative adverse events and additional procedures required, was done. Minimum follow-up was 12 months with an average of 53 months. RESULTS: There was no significant difference (p = 1.000) between the groups in terms of visual acuity improvement rate, 66(ECCE) versus 59(Phaco). Postoperatively IOP with both techniques fell significantly (p < 0.0001). Earlier IOP reduction was obtained with Phacoemulsification, but there was no difference by the end of the follow up period (14.4 mmHg ECCE vs. 14.1 mmHg Phaco, p = 1.0000). Postoperative pressure spikes occurred in 6versus 10(p = 0.3995) of the eyes. No significant difference (55ECCE versus 63Phaco, p = 0.1674) between the two groups in terms of glaucoma medication reduction was found. The total number of postoperative complications (89versus 68.5) were significantly higher (p = 0.0001) in the ECCE-group, as well as the total number of eyes which required further interventions (86versus 64, p = 0.0001). CONCLUSION: Both combined surgery techniques are effective and yielded similar long-term results. However phacoemulsification can decrease the post operative complications associated with this surgery.

Retinitis pigmentosa in Puerto Rico

INTRODUCTION: Previous studies have reported that the prevalence of retinitis pigmentosa (RP) varies between one per 3,000 to one in per 5,000 in the general population. PURPOSE: To study the incidence and ocular findings of RP in a sub-urban community in Puerto Rico. METHODS: We conducted a non-concurrent prospective study of 10,100 patients in a sub-urban San Juan community. RESULTS: 44 out of the 10,100 patients had RP (0.44). Eight out of the 44 patients (18) had nystagmus, twenty-eight (31.8) had microcornea, 3 patients (6.8) had sluggish papillary reaction. Six patients (13.6) had mild cataracts, 27 (65.9)had attenuated retinal vessels and thirty five patients (81.4) had bony spicules. Fifteen patients (34.1) out of the 44 had retinitis pigmentosa as part of the Bardet-Biedl syndrome. CONCLUSION: Incidence of RP in Puerto Rico is higher when compared to Maine and Spain (p < 0.001). Autosomal recessive pattern of inheritance is the most common in Puerto Rico. These findings could be due to the island's geographic isolation, and inbreeding.