Combined cataract and glaucoma surgery: the effect of pupil enlargement on surgical outcomes (an American Ophthalmological Society thesis)

Abstract

Purpose: To determine whether pupil enlargement during phacotrabeculectomy affects postoperative visual acuity and intraocular pressure (IOP) compared to combined surgery without pupil enlargement.

Methods: A retrospective study of 74 patients who underwent combined phacotrabeculectomy with (37 eyes) or without (37 eyes) pupil enlargement was performed. Postoperative outcome measures included best-corrected visual acuity (BCVA), IOP, number of medications, and complications up to 6 months. Wilcoxon-Mann-Whitney test was used to compare outcomes between groups.

Results: Demographic characteristics of the two groups were similar except for diagnosis; chronic angle-closure glaucoma and pseudoexfoliation syndrome were more common in the pupil enlargement group. Preoperatively, the pupil enlargement group had a mean IOP of 21.2 ± 6.6 mm Hg compared to 21.1 ± 6.4 mm Hg for the control group (P=.978, Wilcoxon-Mann-Whitney test). Mean preoperative logMAR equivalent (BCVA) was 0.68 ± 0.67 and 0.63 ± 0.59, respectively (P=.727, Wilcoxon-Mann-Whitney test). At 6 months, mean IOP was 15.5 ± 5.6 mm Hg in the study group and 13.3 ± 4.5 mm Hg in the control group (P=.039, Wilcoxon-Mann-Whitney test). Mean postoperative vision at 6 months was better in the control group (0.36 ± 0.48) vs pupil enlargement group (0.51 ± 0.66) but not statistically different (P=.324 Wilcoxon-Mann-Whitney test). The groups did not differ in number of postoperative glaucoma medications. Complications were rare in both groups.

Conclusion: The results of this study suggest that the outcomes of combined phacoemulsification and trabeculectomy are not adversely impacted by pupil enlargement, although IOP control may be relatively impaired.

FIGURE 1

Histogram of preoperative visual acuity levels of glaucoma patients who underwent combined cataract and glaucoma surgery with (top) and without (bottom) pupil stretch.

FIGURE 2

Histogram of preoperative intraocular pressure levels of glaucoma patients who underwent combined cataract and glaucoma surgery with (top) and without (bottom) pupil stretch.