ABSTRACT
ABSTRACT Purpose: The purpose of this study was to investigate the postoperative outcomes and evaluate the success predictors of phacoemulsification with Kahook Dual Blade goniotomy for cataract and glaucoma management in eyes with primary open-angle glaucoma. Methods: This was a retrospective, non-comparative; inter ventional case series in which all patients with primary open-angle glaucoma who underwent phacoemulsification with Kahook Dual Blade goniotomy between June 2018 and April 2019 were enrolled. All the participants had a minimum follow-up period of 6 months. Preoperative and postoperative intraocular pressure values (at 1, 3, and 6 months), number of antiglaucoma medications, best-corrected visual acuity, surgical complications, and any subsequent related events or procedures were recorded. A logistic regression analysis was performed to investigate the association between the different variables and surgical outcomes. Results: A total of 47 patients (57 eyes) were included (mean age, 70.5 ± 7 years). The mean intraocular pressure was reduced from 15.5 ± 4.2 mmHg to 12.2 ± 2.4 mmHg at the last follow-up visit (p<0.001). The mean number of antiglaucoma medications decreased significantly from 1.9 ± 1.0 to 0.6 ± 1.0 during the same period (p<0.001). On the basis of the predefined criterion (intraocular pressure reduction ≥20% and/or reduction ≥1 medication), the 6-month success rate was 86%. A higher preoperative intraocular pressure value (odds ratio [OR]= 2.01; p=0.016) and greater percentage of initial (30 days) intraocular pressure reduction (OR= 1.02; p=0.033) were sig nificantly associated with surgical success. Conclusion: Our findings suggest that phacoemulsification with Kahook Dual Blade goniotomy is an effective and safe alternative for cataract management in eyes with primary open-angle glaucoma that positively impacts intraocular pressure control and medication burden. Eyes with higher baseline intraocular pressure and a more pronounced initial response to the procedure appeared to present better outcomes at 6 months. Further studies are needed to evaluate the long-term efficacy and safety profile of the procedure.
RESUMO Objetivo: Investigar os resultados pós-operatórios e avaliar os preditores de sucesso da facoemulsificação combinada à goniotomia com o Kahook Dual Blade para o tratamento da catarata e do glaucoma em olhos com glaucoma primário de ângulo aberto. Métodos: Série de casos retrospectivos, não comparativos e intervencionistas, em que todos os pacientes com glaucoma primário de ângulo aberto submetidos ao procedimento de facoemulsificação combinada à goniotomia com o Kahook Dual Blade entre junho de 2018 e abril de 2019 foram inscritos. Todos os participantes tiveram um acompanhamento mínimo de 6 meses. Foram registrados os valores de pressão intraocular pré e pós-operatória (em 1, 3 e 6 meses), número de medicamentos antiglaucomatosos, melhor acuidade visual corrigida, complicações cirúrgicas e quaisquer eventos ou procedimentos subsequentes relacionados. A análise de regressão logística foi usada para investigar a associação entre diferentes variáveis e resultados cirúrgicos. Resultados: Um total de 57 olhos de 47 pacientes foram incluídos (média de idade, 70,5 ± 7 anos). A pressão intraocular média reduziu de 15,5 ± 4,2 mmHg para 12,2 ± 2,4 mmHg na última visita de acompanhamento (p<0,001). O número médio de medicamentos antiglaucomatosos diminuiu significativamente de 1,9 ± 1,0 para 0,6 ± 1,0 durante o mesmo período (p<0,001). Com base no critério predefinido (redução da pressão intraocular ≥20% e/ou redução de ≥1 medicamento), a taxa de sucesso em 6 meses foi de 86%. Um valor de pressão intraocular pré-operatório mais alto (OR= 2,01; p=0,016) e maior porcentagem de redução da pressão intraocular inicial (30 dias) (OR= 1,02; p=0,033) foram significativamente associados ao sucesso cirúrgico. Conclusão: Nossos resultados sugerem que o procedimento de facoemulsificação combinada à goniotomia com o Kahook Dual Blade é uma alternativa eficaz e segura para o manejo da catarata em olhos com glaucoma primário de ângulo aberto, impactando positivamente no controle da pressão intraocular e no número de medicamentos. Olhos com pressão intraocular basal mais alta e resposta inicial mais pronunciada ao procedimento parecem apresentar melhores resultados em 6 meses. Mais estudos são necessários para avaliar a eficácia em longo prazo e o perfil de segurança.
ABSTRACT
Objective To study the different clinical effects between the method ofperipheral iridectomy+trabeculectomy combined with cataract extraction with small incision+intraocular lens implantationand the method ofperipheral iridectomy+trabeculectomy combined with cataract with phacoemulsification+intraocular lens implan-tation,so as to provide guidance for clinic.Methods 40 cases were randomly divided into A and B groups,and A group included 19 patients (31 eyes),while B group included 21 patients (37 eyes).A group was treated with the peripheral iridectomy +trabeculectomy combined with cataract extraction with small incision +intraocular lens implantationmethod,and B group was cured with the method ofperipheral iridectomy+trabeculectomy combined with cataract with phacoemulsification +intraocular lens implantationmethod.In each group,the eye pressures, visual acuity,central anterior chamber depths of before and after treatment were compared to study the clinical effect. And after treatment,the improvement amount of eye pressure,visual acuity,central anterior chamber depths and the complication rates were compared between the two groups,so as to determine the better method.Results After treatment,the eye pressure,visual acuity,central anterior chamber depths in A group were significantly improved [(21.71 ±10.17)mmHg,(0.29 ±0.09)and (1.97 ±0.47)mm,t=11.12,6.93,17.39,all P<0.05].The eye pressure,visual acuity,central anterior chamber depths in B group were significantly improved[(19.45 ±9.54)mmHg, (0.35 ±0.16)and (1.98 ±0.39)mm,t=6.52,5.78,17.78,all P<0.05].After treatment,the eye pressures in A and B groups were cut down[(21.74 ±10.17)and (19.45 ±9.54)mmHg],and there was no statistical significant difference between the two groups (t=0.96,P=0.17).The visual acuity in A and B groups were improved[(0.29 ± 0.09)and (0.35 ±0.16)degrees],and there was no statistically significant difference between the two groups (t=1.86,P=0.97).The central anterior chamber depths in A and B groups were improved[(1.97 ±0.47)and (1.98 ± 0.39)mm],and there was no statistically significant difference between the two groups (t=0.09,P=0.54).The incidence rates of complication in A and B groups were 48.39% and 21.62%,respectively,and the difference between two groups was significant (χ2 =5.44,P=0.02).Conclusion The two treatments had significant and equal clinical effects,while because of its lower incidence rate of complication,the method ofperipheral iridectomy+trabeculectomy combined with cataract with phacoemulsification+intraocular lens implantationis more safe than the other one.
