Outcomes of Ahmed Glaucoma Valve Revision in Pediatric Glaucoma.

Outcomes, Ahmed Glaucoma Valve, Revision, Pediatric, Glaucoma

2017 Sep 13. pii: S0002-9394(17)30392-6. doi: 10.1016/j.ajo.2017.09.015. [Epub ahead of print]

Outcomes of Ahmed Glaucoma Valve Revision in Pediatric Glaucoma.

Abstract

PURPOSE:

Encapsulation of the Ahmed glaucoma valve (AGV) plate is a common cause for postoperative elevation of intraocular pressure, especially in children. Many reports have described the outcomes of AGV revision in adults. However, the outcomes of AGV revision in children are poorly documented. The aim of this study was to determine the outcomes of AGV revision in children.

DESIGN:

Retrospective cross sectional study METHODS: A retrospective chart review of patients less than 15 years of age who underwent AGV revision with a minimum postoperative follow-up of six months was conducted. Outcome measures included: reduction in intraocular pressure from baseline, survival analysis and reduction in the number of anti-glaucoma medications. Postoperative complications were also noted. Complete success was defined as an IOP of 21 mmHg or less without medications, while qualified success was defined as having an IOP of 21 mmHg or less with medications.

RESULTS:

A total of 44 eyes met the inclusion criteria. Primary congenital glaucoma was present in 39 eyes (88.6%), aphakic glaucoma in 4 eyes (9.1%), and Peters anomaly associated glaucoma in 1 eye (2.3%). The mean number of previous surgeries was 1.4, and the mean age was 6.7 years (range 1.9 – 13 years) with a median follow up of 12 months (range; 6 to 24 months). The IOP was reduced from a preoperative mean of 30.4 (±10.3) to 24.9 (±10.6) mmHg at 6 months postoperatively. Kaplan-Meier analysis showed that the complete success at 1 month was 100% followed by a rapid decline at 6 months to 38.6%, 27.7% at one year and 5.5% at 2 years. Qualified success was 100% at 1 month followed by a six-month and 1 year survival rate of approximately 50%, and a two-year survival rate of approximately 16%. The median survival time was 14 months. No specific risk factors for failure were identified. Visual acuity remained unchanged following revision. The most common complication was recurrence of encapsulation with elevated IOP (15.9%). Other complications included hyphema (n=3; 6.8%), endophthalmitis (n=1; 2.3%) wound leak (n=1; 2.3%) and choroidal detachment (n=2; 4.5%).

CONCLUSION:

Although the short-term success rate of AGV revision in children is high, with longer follow-up the success rate decreases significantly.

Outcomes, Ahmed Glaucoma Valve, Revision, Pediatric, Glaucoma

PMID:
28918060
DOI:
10.1016/j.ajo.2017.09.015

Risk Factors for Secondary Glaucoma in Herpetic Anterior Uveitis

2017 Jun 27. pii: S0002-9394(17)30258-1. doi: 10.1016/j.ajo.2017.06.013. [Epub ahead of print]

Risk Factors for Secondary Glaucoma in Herpetic Anterior Uveitis.

Abstract

PURPOSE:

To determine the incidence of elevated intraocular pressure (IOP) and secondary glaucoma in herpetic anterior uveitis (AU), due to either herpes simplex or varicella zoster virus, by using the Standardization of Uveitis Nomenclature (SUN) criteria, and to identify risk factors for the development of glaucoma.

DESIGN:

Retrospective, observational cohort study.

METHODS:

Patients with herpetic AU presenting themselves between 2001 and 2013 at the ophthalmology department of the University Medical Center Groningen were included. Main outcome measures were the incidence of elevated IOP and glaucoma and risk factors for the development of glaucoma.

RESULTS:

Seventy-three herpetic AU patients were included. Ocular complications most commonly seen during follow-up for uveitis were elevated IOP (75%), keratitis (59%), dry eyes (34%), posterior synechiae (34%), cataract (32%), and glaucoma (15%). Glaucoma patients, in comparison to non-glaucoma patients, had a higher number of IOP peaks during their follow-up for uveitis (p<0.001). The majority of patients with elevated IOP (91%) had this already at the start of the uveitis. Nineteen percent of the patients needed glaucoma surgery.

CONCLUSIONS:

Using the SUN criteria, our study confirmed that elevated IOP and secondary glaucoma are major complications in herpetic AU. If an elevated IOP occurred, it was usually already present at the start of a uveitis episode. A risk factor for the development of glaucoma was the number of endured IOP peaks. Future studies are needed to evaluate whether early and prolonged use of antiviral and IOP-lowering medication may prevent glaucoma.

Risk factors, glaucoma, herpetic, uveitis

PMID:
28666730
DOI:
10.1016/j.ajo.2017.06.013

Risk factors for Rapid Glaucoma Disease Progression

Risk Factor, Glaucoma, Progression

2017 Jun 14. pii: S0002-9394(17)30241-6. doi: 10.1016/j.ajo.2017.06.003. [Epub ahead of print]

Risk factors for Rapid Glaucoma Disease Progression.

Abstract

PURPOSE:

To determine the intraocular and systemic risk factor differences between a cohort of rapid glaucoma disease progressors and non-rapid disease progressors.

DESIGN:

Retrospective case control study Methods SETTING: Five private ophthalmology clinics STUDY POPULATION: 48 rapidly progressing eyes (progression ≥1dB mean deviation (MD)/year) and 486 non-rapidly progressing eyes (progression <1dB MD/year). Patients were eligible if they had a diagnosis of glaucoma from their ophthalmologist and if they had greater than or equal to 5 Humphrey visual fields (24-2) conducted. Patients were excluded if their sequential visual fields showed an improvement in MD or if they had greater than 5dB MD variation in between visits. Patients with obvious neurological fields were excluded.

OBSERVATION PROCEDURE:

Clinical and demographic data (age, gender, CCT, IOP, refraction, medications) as well as medical, surgical and ocular histories were collected.

MAIN OUTCOME MEASURES:

Risk factor differences between the cohorts were measured using the independent t-test, Wald chi-squared and binomial regression analysis.

RESULTS:

Rapid progressors were older, had significantly lower CCT and baseline IOPs and were more likely to have pseudoexfoliation, disc haemorrhages, ocular medication changes and IOP lowering surgery. They also had significantly higher rates of cardiovascular disease and hypotension. Subjects with cardiovascular disease were 2.33 times more likely to develop rapidly progressive glaucoma disease despite significantly lower mean and baseline IOPs.

CONCLUSION:

Cardiovascular disease is an important risk factor for rapid glaucoma disease progression irrespective of IOP control.

PMID:
28624324
DOI:
10.1016/j.ajo.2017.06.003
Risk Factor, Glaucoma, Progression

Optic nerves damaged by glaucoma. Not from article

Rates of Local Retinal Nerve Fiber Layer Thinning before and after Disc Hemorrhage in Glaucoma

Retina, Nerve fiber layer, Thinning, Disc hemorrhage, glaucoma
Ophthalmology. 2017 May 9. pii: S0161-6420(16)32367-3. doi: 10.1016/j.ophtha.2017.03.059. [Epub ahead of print]

Rates of Local Retinal Nerve Fiber Layer Thinning before and after Disc Hemorrhage in Glaucoma.

Abstract

Retina, Nerve fiber layer, Thinning, Disc hemorrhage, glaucoma

PURPOSE:

To investigate longitudinal temporal and spatial associations between disc hemorrhage (DH) and rates of local retinal nerve fiber layer (RNFL) thinning before and after DHs.

DESIGN:

Longitudinal, observational cohort study.

PARTICIPANTS:

Forty eyes of 37 participants (23 with glaucoma and 17 with suspect glaucoma at baseline) with DH episodes during follow-up from the Diagnostic Innovations in Glaucoma Study and the African Descent and Glaucoma Evaluation Study.

METHODS:

All subjects underwent optic disc photography annually and spectral-domain optical coherence tomography (OCT) RNFL thickness measurements every 6 months. The rates of RNFL thinning were calculated using multivariate linear mixed-effects models before and after DH.

MAIN OUTCOME MEASURES:

Rates of global and local RNFL thinning.

RESULTS:

Thirty-six eyes of 33 participants with inferior or superior DHs were analyzed. The rates of RNFL thinning were significantly faster in DH quadrants than in non-DH quadrants after DH (-2.25 and -0.69 μm/year; P < 0.001). In the 18 eyes with intensified treatment after DH, the mean rate of RNFL thinning significantly slowed after treatment compared with before treatment in the non-DH quadrants (-2.89 and -0.31 μm/year; P < 0.001), but not in the DH quadrants (-2.64 and -2.12 μm/year; P = 0.19). In 18 eyes with unchanged treatment, the rate of RNFL thinning in the DH quadrant was faster after DH than before DH (P = 0.008). Moreover, compared with eyes without a treatment change, intensification of glaucoma treatment after DH significantly reduced the global, non-DH quadrants, and DH quadrant rates of RNFL thinning after DH compared with before DH (global, P = 0.004; non-DH quadrant, P < 0.001; DH quadrant, P = 0.005). In the multiple linear regression analysis, treatment intensification (β, 1.007; P = 0.005), visual field mean deviation (β, 0.066; P = 0.049), and difference in intraocular pressure before and after DH (β, -0.176; P = 0.034) were associated significantly with the difference of global RNFL slope values before and after DH.

CONCLUSIONS:

Although the rate of RNFL thinning worsened in a DH quadrant after DH, glaucoma treatment intensification may have a beneficial effect in reducing this rate of thinning.

Contribution of Mutations in Known Mendelian Glaucoma Genes to Advanced Early-Onset Primary Open-Angle Glaucoma

Glaucoma, Genes, Mutations

Invest Ophthalmol Vis Sci. 2017 Mar 1;58(3):1537-1544. doi: 10.1167/iovs.16-21049.
Contribution of Mutations in Known Mendelian Glaucoma Genes to Advanced Early-Onset Primary Open-Angle Glaucoma.

Zhou T1, Souzeau E1, Siggs OM1, Landers J1, Mills R1, Goldberg I2, Healey PR3, Graham S4, Hewitt AW5, Mackey DA6, Galanopoulos A7, Casson RJ7, Ruddle JB8, Ellis J9, Leo P9, Brown MA9, MacGregor S10, Sharma S1, Burdon KP11, Craig JE1.
Author information
Abstract
PURPOSE:
Primary open-angle glaucoma (POAG) and primary congenital glaucoma (PCG) with Mendelian inheritance are caused by mutations in at least nine genes. Utilizing whole-exome sequencing, we examined the disease burden accounted for by these known Mendelian glaucoma genes in a cohort of individuals with advanced early-onset POAG.
METHODS:
The cases exhibited advanced POAG with young age of diagnosis. Cases and examined local controls were subjected to whole-exome sequencing. Nine hundred ninety-three previously sequenced exomes of Australian controls were called jointly with our dataset. Qualifying variants were selected based on predicted pathogenicity and rarity in public domain gene variant databases. Case-control mutational burdens were calculated for glaucoma-linked genes.
RESULTS:
Two hundred eighteen unrelated POAG participants and 103 nonglaucomatous controls were included in addition to 993 unexamined controls. Fifty-eight participants (26.6%) harbored rare potentially pathogenic variants in known glaucoma genes. Enrichment of qualifying variants toward glaucoma was present in all genes except WDR36, in which controls harbored more variants, and TBK1, in which no qualifying variants were detected in cases or controls. After multiple testing correction, only MYOC showed statistically significant enrichment of qualifying variants (odds ratio [OR] = 16.62, P = 6.31×10-16).
CONCLUSIONS:
Rare, potentially disease-causing variants in Mendelian POAG genes that showed enrichment in our dataset were found in 22.9% of advanced early-onset POAG cases. MYOC variants represented the largest monogenic cause in POAG. The association between WDR36 and POAG was not supported, and the majority of POAG cases did not harbor a potentially disease-causing variant in the remaining Mendelian genes.

Risk Factors for Glaucoma in a Cohort of Patients with Fuchs Heterochromic Iridocyclitis.

Ocul Immunol Inflamm. 2016 Aug 5:1-7. [Epub ahead of print]

Risk Factors for Glaucoma in a Cohort of Patients with Fuchs Heterochromic Iridocyclitis.

Abstract

PURPOSE:

To describe the incidence and risk factors for ocular hypertension and/or glaucoma in patients with Fuchs heterochromic iridocyclitis (FHC).

METHODS:

Retrospective analysis of 88 patients with FHC. Kaplan-Meier curves estimated the time to develop cataract and ocular hypertension/glaucoma. Possible prognostic factors were investigated in univariate Kaplan-Meier analyses using the Mantel-Cox logrank test.

RESULTS:

At presentation with FHC, 52% of patients had a cataract and 26% of patients had ocular hypertension/glaucoma. The estimated percentage of patients with a cataract or ocular hypertension/glaucoma by 4 years after presentation was 71% (CI: 58-81%) and 39% (CI: 28-51%), respectively. Patients aged ≥50 years had significantly greater risk of developing glaucoma (p = 0.0065). After adjusting for age-group, having a cataract at presentation was associated with increased risk of glaucoma (p = 0.032).

CONCLUSIONS:

Risk factors for development of ocular hypertension/glaucoma were increasing patient age and having a cataract at presentation with FHC.

KEYWORDS:

Cataract; glaucoma; heterochromia; uveitis

Abstract

PURPOSE:

To describe the incidence and risk factors for ocular hypertension and/or glaucoma in patients with Fuchs heterochromic iridocyclitis (FHC).

METHODS:

Retrospective analysis of 88 patients with FHC. Kaplan-Meier curves estimated the time to develop cataract and ocular hypertension/glaucoma. Possible prognostic factors were investigated in univariate Kaplan-Meier analyses using the Mantel-Cox logrank test.

RESULTS:

At presentation with FHC, 52% of patients had a cataract and 26% of patients had ocular hypertension/glaucoma. The estimated percentage of patients with a cataract or ocular hypertension/glaucoma by 4 years after presentation was 71% (CI: 58-81%) and 39% (CI: 28-51%), respectively. Patients aged ≥50 years had significantly greater risk of developing glaucoma (p = 0.0065). After adjusting for age-group, having a cataract at presentation was associated with increased risk of glaucoma (p = 0.032).

CONCLUSIONS:

Risk factors for development of ocular hypertension/glaucoma were increasing patient age and having a cataract at presentation with FHC.

KEYWORDS:

Cataract; glaucoma; heterochromia; uveitis

Associations with Intraocular Pressure in a Large Cohort

Ophthalmology. 2016 Jan 12. pii: S0161-6420(15)01425-6. doi: 10.1016/j.ophtha.2015.11.031. [Epub ahead of print]

Associations with Intraocular Pressure in a Large Cohort: Results from the UK Biobank.

Abstract

PURPOSE:

To describe the associations of physical and demographic factors with Goldmann-correlated intraocular pressure (IOPg) and corneal-compensated intraocular pressure (IOPcc) in a British cohort.

DESIGN:

Cross-sectional study within the UK Biobank, a large-scale multisite cohort study in the United Kingdom.

PARTICIPANTS:

We included 110 573 participants from the UK Biobank with intraocular pressure (IOP) measurements available. Their mean age was 57 years (range, 40-69 years); 54% were women, and 90% were white.

METHODS:

Participants had 1 IOP measurement made on each eye using the Ocular Response Analyzer noncontact tonometer. Linear regression models were used to assess the associations of IOP with physical and demographic factors.

MAIN OUTCOME MEASURES:

The IOPg and IOPcc.

RESULTS:

The mean IOPg was 15.72 mmHg (95% confidence interval [CI], 15.70-15.74 mmHg), and the mean IOPcc was 15.95 mmHg (15.92-15.97 mmHg). After adjusting for covariates, IOPg and IOPcc were both significantly associated with older age, male sex, higher systolic blood pressure (SBP), faster heart rate, greater myopia, self-reported glaucoma, and colder season (all P < 0.001). The strongest determinants of both IOPg and IOPcc were SBP (partial R2: IOPg 2.30%, IOPcc 2.26%), followed by refractive error (IOPg 0.60%, IOPcc 1.04%). The following variables had different directions of association with IOPg and IOPcc: height (-0.77 mmHg/m IOPg; 1.03 mmHg/m IOPcc), smoking (0.19 mmHg IOPg, -0.35 mmHg IOPcc), self-reported diabetes (0.41 mmHg IOPg, -0.05 mmHg IOPcc), and black ethnicity (-0.80 mmHg IOPg, 0.77 mmHg IOPcc). This suggests that height, smoking, diabetes, and ethnicity are related to corneal biomechanical properties. The increase in both IOPg and IOPcc with age was greatest among those of mixed ethnicities, followed by blacks and whites. The same set of covariates explained 7.4% of the variability of IOPcc but only 5.3% of the variability of IOPg.

CONCLUSIONS:

This analysis of associations with IOP in a large cohort demonstrated that some variables clearly have different associations with IOPg and IOPcc, and that these 2 measurements may reflect different biological characteristics.

Anterior chamber aqueous flare, pseudoexfoliation syndrome, and glaucoma.

Anterior chamber,aqueous, flare,pseudoexfoliation syndrome,glaucoma
Int Ophthalmol. 2016 Jan 19. [Epub ahead of print]

Anterior chamber aqueous flare, pseudoexfoliation syndrome, and glaucoma.

Abstract

The purpose of this study is to evaluate anterior chamber aqueous flare (ACAF) in Tunisian patients with pseudoexfoliation (PEX) syndrome with or without associated glaucoma. This is a prospective, cross-sectional, comparative study including 53 patients (88 eyes) with PEX syndrome, 48 patients with PEX glaucoma (86 eyes), and 53 healthy sex-and age-matched control subjects (106 eyes). All patients underwent a complete ophthalmic examination and laser flare photometry. Mean ACAF was significantly higher in the PEX syndrome group in comparison with the control group (17.96 ± 10.05 vs 7.06 ± 2.95 ph/ms; p = 10-4), in patients with PEX glaucoma compared to PEX syndrome without associated glaucoma (27.99 ± 15.45 vs 17.96 ± 10.05 ph/ms; p = 10-4), in the PEX glaucoma group in comparison with control group (27.99 ± 15.45 vs 7.06 ± 2.95 ph/ms; p = 10-4), and in patients with unilateral PEX syndrome in comparison with contralateral-unaffected eyes (25.72 ± 14.88 vs 8.58 ± 3.45 ph/ms; p = 0.000). For patients with PEX syndrome, a high ACAF might be a predictor for the development of glaucoma. Further investigations are needed to clarify the role of laser flare photometry in predicting the risk of glaucoma in patients with PEX syndrome.

KEYWORDS:

Glaucoma; Laser flare photometry; Pseudoexfoliation syndrome

Abstract

The purpose of this study is to evaluate anterior chamber aqueous flare (ACAF) in Tunisian patients with pseudoexfoliation (PEX) syndrome with or without associated glaucoma. This is a prospective, cross-sectional, comparative study including 53 patients (88 eyes) with PEX syndrome, 48 patients with PEX glaucoma (86 eyes), and 53 healthy sex-and age-matched control subjects (106 eyes). All patients underwent a complete ophthalmic examination and laser flare photometry. Mean ACAF was significantly higher in the PEX syndrome group in comparison with the control group (17.96 ± 10.05 vs 7.06 ± 2.95 ph/ms; p = 10-4), in patients with PEX glaucoma compared to PEX syndrome without associated glaucoma (27.99 ± 15.45 vs 17.96 ± 10.05 ph/ms; p = 10-4), in the PEX glaucoma group in comparison with control group (27.99 ± 15.45 vs 7.06 ± 2.95 ph/ms; p = 10-4), and in patients with unilateral PEX syndrome in comparison with contralateral-unaffected eyes (25.72 ± 14.88 vs 8.58 ± 3.45 ph/ms; p = 0.000). For patients with PEX syndrome, a high ACAF might be a predictor for the development of glaucoma. Further investigations are needed to clarify the role of laser flare photometry in predicting the risk of glaucoma in patients with PEX syndrome.

Micro-Bypass Implantation for Primary Open-Angle Glaucoma Combined with Phacoemulsification: 4-Year Follow-Up.

J Ophthalmol. 2015;2015:795357. Epub 2015 Oct 26.

Micro-Bypass Implantation for Primary Open-Angle Glaucoma Combined with Phacoemulsification: 4-Year Follow-Up.

Abstract

Purpose. To report the long-term follow-up results in patients with cataract and primary open-angle glaucoma (POAG) randomly assigned to cataract surgery combined with micro-bypass stent implantation or phacoemulsification alone. Methods. 36 subjects with cataract and POAG were randomized in a 1 : 2 ratio to either iStent implantation and cataract surgery (combined group) or cataract surgery alone (control group). 24 subjects agreed to be evaluated again 48 months after surgery. Patients returned one month later for unmedicated washout assessment. Results. At the long-term follow-up visit we reported a mean IOP of 15,9 ± 2,3 mmHg in the iStent group and 17 ± 2,5 mmHg in the control group (p = NS). After washout, a 14,2% between group difference in favour of the combined group was statistically significant (p = 0,02) for mean IOP reduction. A significant reduction in the mean number of medications was observed in both groups compared to baseline values (p = 0,005 in the combined group and p = 0,01 in the control group). Conclusion. Patients in the combined group maintained low IOP levels after long-term follow-up. Cataract surgery alone showed a loss of efficacy in controlling IOP over time. Both treatments reduced the number of ocular hypotensive medications prescribed. This trial is registered with: NCT00847158.

Abstract

Purpose. To report the long-term follow-up results in patients with cataract and primary open-angle glaucoma (POAG) randomly assigned to cataract surgery combined with micro-bypass stent implantation or phacoemulsification alone. Methods. 36 subjects with cataract and POAG were randomized in a 1 : 2 ratio to either iStent implantation and cataract surgery (combined group) or cataract surgery alone (control group). 24 subjects agreed to be evaluated again 48 months after surgery. Patients returned one month later for unmedicated washout assessment. Results. At the long-term follow-up visit we reported a mean IOP of 15,9 ± 2,3 mmHg in the iStent group and 17 ± 2,5 mmHg in the control group (p = NS). After washout, a 14,2% between group difference in favour of the combined group was statistically significant (p = 0,02) for mean IOP reduction. A significant reduction in the mean number of medications was observed in both groups compared to baseline values (p = 0,005 in the combined group and p = 0,01 in the control group). Conclusion. Patients in the combined group maintained low IOP levels after long-term follow-up. Cataract surgery alone showed a loss of efficacy in controlling IOP over time. Both treatments reduced the number of ocular hypotensive medications prescribed. This trial is registered with: NCT00847158.

The Effect of Phacoemulsification on Intraocular Pressure in Glaucoma Patients:

phacoemulsification, IOP, cataract surgery, glaucoma, eye surgery

Ophthalmology. 2015 Jul;122(7):1294-307. doi: 10.1016/j.ophtha.2015.03.021. Epub 2015 May 2.
The Effect of Phacoemulsification on Intraocular Pressure in Glaucoma Patients: A Report by the American Academy of Ophthalmology.
Chen PP1, Lin SC2, Junk AK3, Radhakrishnan S4, Singh K5, Chen TC6.
Author information
Abstract
OBJECTIVE:
To examine effects of phacoemulsification on longer-term intraocular pressure (IOP) in patients with medically treated primary open-angle glaucoma (POAG; including normal-tension glaucoma), pseudoexfoliation glaucoma (PXG), or primary angle-closure glaucoma (PACG), without prior or concurrent incisional glaucoma surgery.
METHODS:
PubMed and Cochrane database searches, last conducted in December 2014, yielded 541 unique citations. Panel members reviewed titles and abstracts and selected 86 for further review. The panel reviewed these articles and identified 32 studies meeting the inclusion criteria, for which the panel methodologist assigned a level of evidence based on standardized grading adopted by the American Academy of Ophthalmology. One, 15, and 16 studies were rated as providing level I, II, and III evidence, respectively.
RESULTS:
All follow-up, IOP, and medication data listed are weighted means. In general, the studies reported on patients using few glaucoma medications (1.5-1.9 before surgery among the different diagnoses). For POAG, 9 studies (total, 461 patients; follow-up, 17 months) showed that phacoemulsification reduced IOP by 13% and glaucoma medications by 12%. For PXG, 5 studies (total, 132 patients; follow-up, 34 months) showed phacoemulsification reduced IOP by 20% and glaucoma medications by 35%. For chronic PACG, 12 studies (total, 495 patients; follow-up, 16 months) showed phacoemulsification reduced IOP by 30% and glaucoma medications by 58%. Patients with acute PACG (4 studies; total, 119 patients; follow-up, 24 months) had a 71% reduction from presenting IOP and rarely required long-term glaucoma medications when phacoemulsification was performed soon after medical reduction of IOP. Trabeculectomy after phacoemulsification was uncommon; the median rate reported within 6 to 24 months of follow-up in patients with controlled POAG, PXG, or PACG was 0% and was 7% in patients with uncontrolled chronic PACG.
CONCLUSIONS:
Phacoemulsification typically results in small, moderate, and marked reductions of IOP and medications for patients with POAG, PXG, and PACG, respectively, and using 1 to 2 medications before surgery. Trabeculectomy within 6 to 24 months after phacoemulsification is rare in such patients. However, reports on its effects in eyes with advanced disease or poor IOP control before surgery are few, particularly for POAG and PXG.