Phacotrabeculectomy well-tolerated in uveitic eyes

With appropriate inflammation control, combined phacoemulsification and trabeculectomy with mitomycin-C improved vision and controlled IOP in patients with inactive uveitis and coexisting cataract and glaucoma, a study found. The procedure was well-tolerated, but IOP control was less effective in uveitic eyes than in nonuveitic eyes at long-term follow-up, the study authors said.

Un-Chul Park, MD, of Seoul National University College of Medicine, and colleagues reviewed the results of the procedure in 23 eyes of 23 patients with uveitis that had been in remission for at least 3 months. They compared these outcomes to those in a control group 43 nonuveitic eyes also treated with phacotrabeculectomy.

All patients in the study group underwent phacoemulsification with IOL implantation and trabeculectomy with adjuvant use of mitomycin-C (MMC) to enhance filtration success. In the control group, only three eyes received MMC.

Both groups had similar preoperative IOPs. Control eyes had significantly better mean preoperative logMAR best corrected visual acuity, 0.79 vs. 1.22 in the uveitis group. Both groups had similar mean BCVA at 1 year postoperative: 0.43 in the uveitic group and 0.34 in the control group.

Combined surgery significantly lowered IOP in both groups, but significantly more control eyes achieved complete success at 1 year and at final follow-up. Complete success was defined as an IOP below 22 mm Hg without use of glaucoma medications, no need for further glaucoma surgery and no devastating complications.

Control eyes also had a higher cumulative probability for overall success (P = .0423). Specifically, the probability for overall success was 97.7% at 6 months and 95.4% at 1 year, 2 years and 3 years follow-up for control eyes. Comparatively, uveitic eyes had an overall success probability of 100% at 6 months, 91.3% at 1 year, 84.8% at 2 years and 65.9% at 3 years.

Five uveitic eyes failed within 1 year, four of which experienced acute relapse of inflammation postoperatively. Of these, three required Ahmed valve implantation and one required an additional trabeculectomy with MMC. At final follow-up, IOP was controlled below 21 mm Hg in these four eyes, the study authors said.

The researchers found that trabeculectomy failure was significantly associated with postoperative relapse of uveitis and IOP spikes.

The authors found no significant difference in complications between the groups, although three eyes in the control group developed posterior capsule rupture.

The study is published in the December issue of the American Journal of Ophthalmology.