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Glaucoma surgery calculator: Limited additive effect of phacoemulsification on intraocular pressure in ab interno trabeculectomy

Neiweem, AE and Bussel, II and Schuman, JS and Brown, EN and Loewen, NA (2016) Glaucoma surgery calculator: Limited additive effect of phacoemulsification on intraocular pressure in ab interno trabeculectomy. PLoS ONE, 11 (4).

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© 2016 Neiweem et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Purpose To compare intraocular pressure (IOP) reduction and to develop a predictive surgery calculator based on the results between trabectome-mediated ab interno trabeculectomy in pseudophakic patients versus phacoemulsification combined with trabectome-mediated ab interno trabeculectomy in phakic patients. Methods This observational surgical cohort study analyzed pseudophakic patients who received trabectome-mediated ab interno trabeculectomy (AIT) or phacoemulsification combined with AIT (phaco-AIT). Follow up for less than 12 months or neovascular glaucoma led to exclusion. Missing data was imputed by generating 5 similar but non-identical datasets. Groups were matched using Coarsened Exact Matching based on age, gender, type of glaucoma, race, preoperative number of glaucoma medications and baseline intraocular pressure (IOP). Linear regression was used to examine the outcome measures consisting of IOP and medications. Results Of 949 cases, 587 were included consisting of 235 AIT and 352 phaco-AIT. Baseline IOP between groups was statistically significant (p≤0.01) in linear regression models and was minimized after Coarsened Exact Matching. An increment of 1 mmHg in baseline IOP was associated with a 0.73±0.03 mmHg IOP reduction. Phaco-AIT had an IOP reduction thatwasonly0.73±0.32 mmHg greater than that of AIT. The resulting calculator to determine IOP reduction consisted of the formula -13.54+0.73 ? (phacoemulsification yes:1, no:0) + 0.73 ? (baseline IOP) + 0.59 ? (secondary open angle glaucoma yes:1, no:0) + 0.03 ? (age) + 0.09 ? (medications). Conclusions This predictive calculator for minimally invasive glaucoma surgery can assist clinical decision making. Only a small additional IOP reduction was observed when phacoemulsification was added to AIT. Patients with a higher baseline IOP had a greater IOP reduction.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Neiweem, AE
Bussel, II
Schuman, JSjss28@pitt.eduJSS280000-0002-8885-3766
Brown, EN
Loewen, NANAL58@pitt.eduNAL58
ContributionContributors NameEmailPitt UsernameORCID
Date: 1 April 2016
Date Type: Publication
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Journal or Publication Title: PLoS ONE
Volume: 11
Number: 4
DOI or Unique Handle: 10.1371/journal.pone.0153585
Institution: University of Pittsburgh
Schools and Programs: School of Medicine > Ophthalmology
Refereed: Yes
Date Deposited: 31 Aug 2016 17:30
Last Modified: 04 Feb 2019 15:58


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