Effect of technique on intraocular pressure after combined cataract and glaucoma surgery: An evidence-based review☆
Received 19 November 2001; accepted 14 August 2002.
Abstract
Topic
To analyze the literature pertaining to the techniques used in combined cataract and glaucoma surgery, including the technique of cataract extraction, the timing of the surgery (staged procedure versus combined procedure), the anatomic location of the operation, and the use of antifibrosis agents.
Clinical relevance
Cataract and glaucoma are both common conditions and are often present in the same patient. There is no agreement concerning the optimal surgical management of these disorders when they coexist.
Methods/literature reviewed
Electronic searches of English language articles published since 1964 were conducted in Pub MED and CENTRAL, the Cochrane Collaboration’s database. These were augmented by a hand search of six ophthalmology journals and the reference lists of a sample of studies included in the literature review. Evidence grades (A, strong; B, moderate; C, weak; I, insufficient) were assigned to the evidence that involved a direct comparison of alternative techniques.
Results
The preponderance of evidence from the literature suggests a small (2–4 mmHg) benefit from the use of mitomycin-C (MMC), but not 5-fluorouracil (5-FU), in combined cataract and glaucoma surgery (evidence grade B). Two-site surgery provides slightly lower (1–3 mmHg) intraocular pressure (IOP) than one-site surgery (evidence grade C), and IOP is lowered more (1–3 mmHg) by phacoemulsification than by nuclear expression in combined procedures (evidence grade C). There is insufficient evidence to conclude either that staged or combined procedures give better results or that alternative glaucoma procedures are superior to trabeculectomy in combined procedures.
Conclusions
In the literature on surgical techniques and adjuvants used in the management of coexisting cataract and glaucoma, the strongest evidence of efficacy exists for using MMC, separating the incisions for cataract and glaucoma surgery, and removing the nucleus by phacoemulsification.
1Department of Ophthalmology, Johns Hopkins University, Baltimore, Maryland,USA
2Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland,USA
3Department of Medicine, Johns Hopkins University, Baltimore, Maryland,USA
4Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland,USA
Reprint requests to Henry D. Jampel, MD, Maumenee B-110, Johns Hopkins Hospital, 600 N. Wolfe Street, Baltimore, MD 21287., USA
Dr. Friedman is supported in part by the National Eye Institute, National Institutes of Health (US Public Health Service grant no. EY00358), Bethesda, Maryland, and the Robert E. McCormick Award from Research to Prevent Blindness, New York, New York; Dr. Kempen is supported in part by the National Eye Institute, National Institutes of Health (US PublicHealth Service grant no. NEI EY00386), Bethesda, Maryland; Dr. Congdon is supported by the National Eye Institute, National Institutes of Health (US Public Health Service grant no. EY00388), Bethesda, Maryland, and a Career Development Award from Research to Prevent Blindness, New York, New York.
This article is based on research conducted by the Johns Hopkins University Evidence-based Practice Center under contract to the Agency for Healthcare Research and Quality (Contract No. 290-97-0006), Rockville, Maryland. The authors of this article are responsible for its contents, including any clinical or treatment recommendations. No statement in this article should be construed as an official position of the Agency for Healthcare Research and Quality or the US Department of Health and Human Services.
ABSTRACT