Effect of Prior Phacoemulsification Surgery in Trabeculectomy Surgery Outcomes

Figures & data

Table 1 Preoperative Characteristics of Eyes Submitted to Trabeculectomy in Phakic and Pseudophakic Patients

	Phakic Group (n=58)	Pseudophakic Group (n =24)	P value
Sex n (%) male	39 (67.2)	12 (50.0)	0.143*
Age y mean (SD) (range)	65.8 (11.7) (37–84)	76.2 (7.9) (52–86)	<0.001^†
Type of glaucoma n (%)			0.880*
POAG	34 (59)	15 (63)
XFG	20 (35)	8 (33)
PG	4 (7)	1 (4)
Preoperative IOP mmHg mean (SD) (range)	26.2 (8.6) (14.0–56.0)	24.5 (9.2) (5.0–40.0)	0.678^†
Preoperative hypotensive medications n (%)
Mean (SD)	3.14 (0.93)	3.26 (0.92)	0.601^‡
Median (Range)	3.0 (0–4)	4.0 (1–4)	0.556^†
Number of drugs
PGA n (%)	36 (62.1)	16 (66.7)	0.694*
Betablocker n (%)	2 (3.4)	5 (20.8)	0.021**
CAI n (%)	11 (19)	6 (25)	0.559**
Alfa-agonist n (%)	36 (62.1)	11 (45.8)	0.176*
BB_PGA n (%)	19 (32.8)	4 (16.7)	0.140*
BB_CAI n (%)	28 (48.3)	11 (45.8)	0.840*
BB_Aa n (%)	2 (3.4)	2 (8.3)	0.577**
Aa_CAI n (%)	1 (1.7)	2 (8.3)	0.204**
CAI oral n (%)	7 (12.3)	1 (4.3)	0.427**
Preoperative BCVA logMAR mean (SD) (Range)	0.36 (0.52) (0.0–2.0)	0.44 (0.57) (0.0–2.0)	0.518^†
Intraoperative use of antimetabolite n (%)
5-FU	52 (90)	18 (75)	0.100**
MMC	6 (10)	6 (25)

Notes: *Chi square test, **Fisher’s exact test, ^†Mann–Whitney U-test, ^‡Independent t-test.

Abbreviations: Aa_CAI, alfa2 adrenergic agonist plus carbonic anhydrase inhibitor; BB, betablocker; BB_Aa, betablocker plus alfa2 adrenergic agonist; BB_PGA, betablocker plus prostaglandin analog; BB_CAI, betablocker plus carbonic anhydrase inhibitor; BCVA, best-corrected visual acuity; CAI, Carbonic anhydrase inhibitors; IOP, intraocular pressure; logMAR, logarithm of the minimum angle of resolution; MMC, mitomycin C; n, number; PG, pigmentary glaucoma; PGA, prostaglandin analogs; POAG, primary open-angle glaucoma; SD, standard deviation; XFG, exfoliative glaucoma; y, years; 5-FU, 5-fluorouracil.

Figure 1 Survival analysis Kaplan–Meier curves for failure.

Notes: phakic = 0 corresponds to the phakic group and phakic = 1 to the pseudophakic group. Log rank test p = 0.107.

Table 2 Intraocular Pressure and the Number of Postoperative Hypotensive Medications Over Time After Trabeculectomy

Time	IOP mmHg Mean (SD) (Range)			No. of Postoperative Hypotensive Medications Mean (SD) (Range)
	Phakic Group	Pseudophakic Group	P value	Phakic Group	Pseudophakic Group	P value
2 w	9.1 (5.1) (1.0–23.0)	10.4 (4.9) (2.0–20.0)	0.273^‡	0	0	NA
1 mo	12.9 (6.3) (3.0–40.0)	14.3 (7.3) (5.0–30.0)	0.427^†	0	0.17 (0.56) (0.0–2.0)	0.028^†
3 mo	13.5 (4.3) (6.0–25.0)	13.6 (4.6) (4.0–21)	0.918^†	0.21 (0.62) (0.0–3.0)	0.61 (0.99) (0.0–3.0)	0.049^†
6 mo	13.5 (5.7) (4.0–36.0)	13.0 (4.6) (4.0–19.0)	0.837^†	0.37 (0.77) (0.0–3.0)	0.68 (1.00) (0.0–3.0)	0.179^†
9 mo	13.9 (5.9) (5.0–36.0)	15.9 (6.0) (5.0–29.0)	0.168^†	0.44 (0.91) (0.00–3.0)	0.67 (0.90) (0.0–2.0)	0.268^†
12 mo	14.0 (5.5) (6.0–40.0)	14.0 (4.6) (8.0–26.0)	0.918^†	0.55 (0.94) (0.00–3.0)	0.89 (1.32) (0.0–4.0)	0.424^†
24 mo	14.4 (5.1) (8.0–35.0)	14.4 (3.9) (7.0–20.0)	0.649^†	0.79 (1.11) (0.00–3.0)	1.20 (1.32) (0.0–4.0)	0.288^†

Notes: ^†Mann–Whitney U-test, ^‡Independent t-test.

Abbreviations: IOP, intraocular pressure; SD, standard deviation; w, weeks; mo, months; NA, not applicable.

Figure 2 Intraocular pressure variation after trabeculectomy.

Notes: No statistically significant differences in IOP values between phakic and pseudophakic eyes were identified at any time point.

Abbreviations: IOP, intraocular pressure; w, weeks; m, months.

Table 3 Postoperative BCVA Variation After Trabeculectomy

BCVA LogMAR (SD) (Range)	Phakic Group	Pseudophakic Group	p value
Preoperative	0.36 (0.52) (0.0–2.0)	0.44 (0.57) (0.0–2.0)	0.518^†
6 mo	0.43 (0.75) (0.0–3.0)	0.41 (0.60) (0.0–2.0)	0.709^†
12 mo	0.64 (0.87) (0.0–3.0)	0.35 (0.56) (0.0–2.0)	0.344^†
24 mo	0.61 (0.85) (0.0–3.0)	0.29 (0.50) (0.0–2.0)	0.211^†

Note: ^†Mann–Whitney U-test.

Abbreviations: BCVA, best-corrected visual acuity; logMAR, logarithm of the minimum angle of resolution; mo, months; SD, standard deviation.

Table 4 Postoperative Complications and Procedures in Pseudophakic and Phakic Eyes

Postoperative Complication n (%)	Phakic Group (n = 58)	Pseudophakic Group (n = 24)	p value
Cataract progression requiring phacoemulsification surgery	13 (22)	NA	NA
Choroidal detachment	6 (10)	5 (21)	0.285**
Flat anterior chamber	8 (14)	2 (8)	0.716**
Hyphema	3 (5)	1 (4)	1.000**
Hemovitreous	0	0	NA
Wound leak	36 (62)	11 (46)	0.176*
Bleb leak	2 (3)	2 (8)	0.577**
Hypotony maculopathy	2 (3)	0	1.000**
Blebitis	0	0	NA
Endophthalmitis	1 (2)	0	1.000**
Needling
At 1 year	8 (14)	4 (17)	0.740**
At 2 years	0	0	NA
Surgical bleb revision	0	0	NA
Additional glaucoma surgery	4 (7)	3 (13)	0.687**
Trabeculectomy	1 (2)	1 (4)	0.502**
Ahmed glaucoma valve	3 (5)	2 (8)	0.627**

Notes: * Chi square test, ** Fisher’s exact test.

Abbreviations: n, number; NA, not applicable.