Combined Phacoemulsification and Nonpenetrating Deep Sclerectomy in the Treatment of Chronic Angle-Closure Glaucoma with Cataract

Abstract

Purpose To review the result of nonpenetrating deep sclerectomy (NPDS) combined with phacoemulsification in the treatment of chronic angle-closure glaucoma (CACG) with coexisting cataract. Methods This is a retrospective review of 29 eyes of 26 patients who had undergone combined non-penetrating deep sclerectomy and phacoemulsification for cataract and chronic angle-closure glaucoma between January 2001 and June 2003. The visual acuity, intraocular pressure (IOP) and complications were analyzed. Results The mean follow-up period was 33.8 months (range 23.3 to 54.0 months). Postoperative visual acuity improved in 21 eyes (72%) and remained the same in 6 eyes (21%). The IOP was reduced significantly from 20.3±3.9 mmHg (mean ± SD) preoperatively to 15.9±3.1 mmHg postoperatively at last follow-up visit (p<0.001). The number of antiglaucoma medications was also reduced significantly from 2.9±0.8 (mean ± SD) preoperatively to 1.0±1.2 at last follow-up (p<0.001). Fifteen eyes (52%) achieved complete success with IOP ≤ 21 mmHg without antiglaucoma medications and 25 eyes (86%) achieved qualified success with IOP ≤ 21 mmHg with or without medications at the last follow-up visit. Of the 25 eyes achieving qualified success, 24 (96%) had a reduction in the number of medications. There were 4 failures, defined as uncontrolled IOP requiring further filtering operation or oral drug treatment. Intraoperative complications included one accidental anterior chamber puncture and one iris plug intraoperatively. Postoperative complications included one choroidal effusion, three wound leaks requiring repair, and two punctate epithelial erosions. There was no shallowing of the anterior chamber, hyphema, hypotony, or infection encountered. Conclusions Combined NPDS and phacoemulsification could be a safe and effective surgical option for the management of CACG with cataract. (Eur J Ophthalmol 2007; 17: 208–15)