Comparative Analysis of Filtering Surgery Approaches in Non-Granulomatous Uveitic Glaucoma: Combined or Standalone?

Öz

Objectives: To compare the 36-month outcomes of trabeculectomy alone versus combined phacotrabeculectomy in patients with non-granulomatous uveitic glaucoma (UG), focusing on intraocular pressure (IOP) control, surgical success, and postoperative intervention requirements. Methods: In this retrospective cohort study, 62 eyes with medically uncontrolled non-granulomatous UG were included. Patients were divided into two groups: Group 1 underwent combined phacoemulsification and trabeculectomy, while Group 2 underwent trabeculectomy alone. Preoperative and postoperative IOP measurements were evaluated over 36 months. Surgical success was defined as IOP between 5 and 21 mmHg, without additional glaucoma procedures or significant vision loss. Postoperative complications, medication requirements, and needling rates were also assessed. Results: The mean follow-up period was 36 months. The cumulative surgical success rate was higher in the combined group (88.2%) than in the trabeculectomy-alone group (71.1%), although the difference was not statistically significant (p > 0.05). Needling was significantly more frequent in Group 2 (p < 0.05), and more patients in Group 2 required antiglaucomatous medications postoperatively. No significant differences in complication rates or visual outcomes were observed between the groups. Conclusion: Both surgical approaches provide effective IOP control in uveitic glaucoma; however, combined surgery may result in fewer postoperative interventions and a trend toward improved 36-month surgical success. Careful patient selection and inflammation control remain crucial in optimizing outcomes.

Anahtar Kelimeler

• Uveitic glaucoma
• Trabeculectomy;
• Phacotrabeculectomy; Intraocular pressure; Surgical outcome.

Granülomatöz Olmayan Üveitik Glokomda Filtreleme Cerrahisi Yaklaşımlarının Karşılaştırmalı Analizi: Kombine, Tek Başına?

Öz

Amaç: Granülomatöz olmayan üveitik glokom (ÜG) hastalarında yalnız trabekülektomi ile kombine fakotrabekülektomi cerrahisinin 36 aylık sonuçlarını karşılaştırmak; özellikle göz içi basıncı (GİB) kontrolü, cerrahi başarı oranı ve postoperatif müdahale gereksinimlerine odaklanmak. Yöntemler: Bu retrospektif kohort çalışmaya, medikal tedaviye dirençli granülomatöz olmayan ÜG tanısı almış 62 göz dâhil edildi. Hastalar iki gruba ayrıldı: Grup 1’e kombine fakoemülsifikasyon ve trabekülektomi uygulandı, Grup 2’ye yalnız trabekülektomi yapıldı. Preoperatif ve postoperatif GİB ölçümleri 36 ay boyunca izlendi. Cerrahi başarı, GİB’in 5–21 mmHg aralığında olması, ek glokom cerrahisi ihtiyacının olmaması ve belirgin görme kaybının gelişmemesi kriterleriyle tanımlandı. Postoperatif komplikasyonlar, medikal tedavi ihtiyacı ve needling oranları da değerlendirildi. Bulgular: Ortalama takip süresi 36 ay idi. Kümülatif cerrahi başarı oranı kombine grupta (%88,2), yalnız trabekülektomi grubuna (%71,1) kıyasla daha yüksek olmakla birlikte, bu fark istatistiksel olarak anlamlı değildi (p > 0,05). Needling uygulaması Grup 2’de anlamlı düzeyde daha sık gözlendi (p < 0,05) ve bu gruptaki hastaların daha fazla kısmı postoperatif dönemde antiglaukomatöz tedaviye ihtiyaç duydu. Gruplar arasında komplikasyon oranları ve görsel sonuçlar açısından anlamlı fark saptanmadı. Sonuç: Her iki cerrahi yöntem de üveitik glokomda etkili GİB kontrolü sağlamaktadır. Bununla birlikte, kombine cerrahi daha az postoperatif müdahale gereksinimi ve 36 aylık dönemde daha yüksek cerrahi başarı eğilimi göstermektedir. Uygun hasta seçimi ve inflamasyonun optimal kontrolü, cerrahi başarının artırılmasında kilit öneme sahiptir.

Anahtar Kelimeler

• Üveitik glokom
• Trabekülektomi;
• Fakotrabekülektomi; Göz içi basıncı; Cerrahi sonuç.

Kaynakça

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