Outcomes of combined phacoemulsification and deep sclerectomy: a 10-year UK single-centre study

Abstract

Purpose: To report the outcomes of combined phacoemulsification and -deep sclerectomy (phaco-DS) from a single UK centre over a 10-year period.

Methods: Retrospective analysis of phaco-DS data extracted from an ongoing glaucoma surgery database within Calderdale and Huddersfield NHS Trust. Two hundred and ninety-six eyes of 282 patients were included. Data included patient demographics, pre- and postoperative intraocular pressure (IOP), use of mitomycin C (MMC), spacer device implantation, and follow-up details including surgical success rates. IOP success criteria were: (A) IOP <19 mm Hg and/or 20% decrease from baseline and (B) IOP <16 mm Hg and/or 30% drop from baseline.

Results: Mean follow-up was 63.5 ± 35.3 months. MMC was applied in 145 eyes (49%). Kaplan-Meier success rates in all eyes for criteria A were 89.1% and 80% with glaucoma medications (qualified success) and 81.2% and 68.3% without medications (unqualified success) at 2 and 5 years, respectively. Qualified success for criteria B was 72.4 and 61.4% and unqualified rates were 67.2 and 55.2% for the same time periods. Repeated-measures ANOVA showed significantly lower IOP in the phaco-DS with MMC group up to 3 years postoperatively (P = 0.002). Cox's proportional hazards for criteria B, however, showed no significant effect of MMC application in the long term (P = 0.2). Increasing age and laser goniopuncture were positively associated with success, whereas the absence of spacer devices was negatively associated. At last follow-up, 20% of eyes were on glaucoma medications. Complication rates were low with hypotony rates of 0.68%.

Conclusions: This study confirms the long-term safety and efficacy of phaco-DS as a primary glaucoma procedure.

Figures

Figure 1

(a) Mean decimalised VA changes (pre-op, preoperative VA; W, week; M, month; Y, year; error bars—95% confidence intervals). (b) Mean IOP (mm Hg) changes after phaco-DS with 95% confidence intervals over a 5-year follow-up period. Qualified and unqualified success rates for both sets of defined criteria at 2, 3, and 5 years are summarised in the table (bottom).

Figure 2

Kaplan–Meier curves for drainage procedure survival probability after phaco-DS (solid lines, phaco-DS with MMC; broken lines, phaco-DS without MMC). (a) IOP