EX-PRESS drainage device implantation combined with phacoemulsification for chronic primary angle-closure glaucoma complicated with cataract

Abstract

AIM: To evaluate the efficacy of EX-PRESS drainage device implantation combined with phacoemulsification for chronic primary angle-closure glaucoma(CPACG)with cataract and compare with trabeculectomy combined with phacoemulsification. METHODS: A retrospective case control design was used in this study. The patients underwent combined operation of glaucoma and cataract in the ophthalmology department of our hospital from January 1st, 2017 to January 1st, 2019 were collected and divided into two groups according to different operation methods. The study group(13 cases, 16 eyes)was treated with EX-PRESS drainage device implantation combined with phacoemulsification and intraocular lens implantation. The control group(16 cases, 20 eyes)was treated with trabeculectomy combined with phacoemulsification and intraocular lens implantation. The best corrected visual acuity(BCVA)and intraocular pressure(IOP)at 1wk, 1, 3, 6mo after surgery, central anterior chamber depth(ACD)at before surgery, 1, 6mo after surgery, central corneal endothelial cell count, the duration of operation, length of hospital stays after surgery were compared between the two groups. RESULTS:The demography was matched between the two groups(all P >0.05). The number of eyes with visual improvement was significantly raised 6mo after treatment in study group(Z=-2.066,P=0.039). There were no significant differences in BCVA between two groups 6mo after treatment(Z=-0.319,P=0.765). The IOP of study group at 1wk, 1, 3 and 6mo was significantly lower than that before operation(all P0.05). The duration of operation was 26.1±4.5min in study group and 31.5±5.1min in control group, which showed significant differences(t=-3.307, P=0.002). The length of stays after surgery was 7.2±1.6d in study group and 7.7±1.5d in control group, and there was no significant difference between the two groups(t=-0.880, P=0.388). One eye EX-PRESS touched the iris in study group. Since the IOP was normal, it didn't receive therapy. In control group, the anterior chamber of 2 eyes was 2 degrees shallow after surgery, which recovered in 1wk by pupil dilation and pressurized bandage. At 6mo point after operation, one eye in each group was treated with one IOP drop to maintain normal IOP. In control group, one case received EX-PRESS drainage device implantation again 12mo later for recurrent glaucoma, another case underwent ciliary body photocoagulation 8mo later. CONCLUSION: EX-PRESS drainage device combined with phacoemulsification is effective in improving visual acuity and controlling IOP for CPACG, and it takes shorten operation time compared with trabeculectomy combined with phacoemulsification.

Keywords

• ex-press drainage device
• glaucoma
• cataract
• combined surgery