TO STUDY THE OUTCOMES OF SMALL INCISION CATARACT SURGERY AND TRABECULECTOMY (COMBINED SURGERY) AT GMC AKOLA.
Main Article Content
Keywords
Cataract, Glaucoma, MSICS-Trabeculectomy, Intraocular Pressure, Vision Restoration
Abstract
Patients who have both cataracts and glaucoma frequently develop these conditions together during their elderly years, so surgeons perform combined surgical procedures to prevent multiple surgeries and enhance treatment results. The study evaluated the IOP control and visual restoration outcomes of combined manual small incision cataract surgery with trabeculectomy (MSICS-Trab) procedures. The study evaluated 53 eye procedures from 49 patients who received MSICS-Trab surgery at GMC Akola. The study followed patient outcomes for one year after surgery. The study evaluated preoperative and postoperative measurements of intraocular pressure alongside visual acuity findings and examination of treatment complications and drug utilization. The mean IOP value decreased to 13.41 mmHg from its initial measurement of 27.04 mmHg. 69.8% of eyes reached ≥6/18 visual acuity while becoming medication-free during the twelve months. The procedure demonstrated high complete success rates alongside a low occurrence of complications. The MSICS-Trab procedure presents a secure effective, and practical approach to manage glaucoma and cataracts simultaneously in tertiary care facilities with limited resources.
References
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20. Andini EA, Avianty A, Herman H, Choliq A. Efficacy and Safety of Manual Small-Incision Cataract Surgery With Trabeculectomy Versus Phacotrabeculectomy in Patients With Glaucoma and Cataract: A Systematic Review and Meta-Analysis. Cureus. 2023 Dec 24;15(12).
21. Jacob JM, Jacob AD, Goudinho S. The effect of manual small incision cataract surgery on the intraocular pressure− A prospective study in south Kerala. Indian J Clin Exp Ophthalmol. 2018 Jul;4(3):409-12.
22. Venkatesh R, Annamalai O, Robin AL. Managing Cataract and Glaucoma in the Developing World: Manual Small Incision Cataract Surgery (MSICS) Combined with Trabeculectomy. In Cataract Surgery in the Glaucoma Patient 2025 Feb 7 (pp. 115-128). Cham: Springer Nature Switzerland.
23. Yang SA, Ciociola EC, Mitchell W, Hall N, Lorch AC, Miller JW, Friedman DS, Boland MV, Elze T, Zebardast N, Pershing S. Effectiveness of microinvasive glaucoma surgery in the United States: intelligent research in sight registry analysis 2013–2019. Ophthalmology. 2023 Mar 1;130(3):242-55.
24. Richter GM, Coleman AL. Minimally invasive glaucoma surgery: current status and prospects. Clinical ophthalmology. 2016 Jan 28:189-206.
25. Amaral DC, Guedes J, de Oliveira Caneca K, Pereira SF, Alves MR, Manso JE, Ribeiro Monteiro ML, Louzada RN. Manual small incision cataract surgery combined with trabeculectomy versus phacoemulsification combined with trabeculectomy for coexisting glaucoma and cataract: a systematic review and meta-analysis. Expert Review of Ophthalmology. 2024 Jul 3;19(4):281-9.
26. Giorgis AT, Worku A. Outcomes of Combined Manual Small Incision Cataract Surgery and Trabeculectomy. Ethiopian Medical Journal. 2019 Jun 28;57(3).
27. Ramjee P, Sachdeva B, Golechha S, Kulkarni S, Fulari G, Murali K, Jain M. CataractBot: an LLM-powered expert-in-the-loop chatbot for cataract patients. arXiv preprint arXiv:2402.04620. 2024 Feb 7.
28. Guedes J, Pereira SF, Amaral DC, Hespanhol LC, Faneli AC, Oliveira RD, Mora-Paez DJ, Fontes BM. Phaco-chop versus divide-and-conquer in patients who underwent cataract surgery: a systematic review and meta-analysis. Clinical Ophthalmology. 2024 Dec 31:1535-46.
29. Khandelwal RR, Raje D, Rathi A, Agashe A, Majumdar M, Khandelwal R. Surgical outcome of safe surgery system trabeculectomy combined with cataract extraction. Eye. 2015 Mar;29(3):363-70.
30. Marchini G, Ceruti P, Vizzari G, Berzaghi D, Zampieri A. Management of concomitant cataract and glaucoma. Developments in Ophthalmology. 2017 Apr 25;59:155-64.
31. Rao A, Cruz RD. Cataract versus combined surgery in pseudoexfoliation glaucoma. Indian Journal of Ophthalmology. 2023 Mar 1;71(3):797-802.
32. Ndife TI, Abdullahi SM, Raji L, Umar MM, Olaniyi S, Alhassan MB. Long-term outcome of Trabeculectomy with and without small incision cataract surgery at a tertiary eye hospital in Northern Nigeria. Nigerian Journal of Ophthalmology. 2017 Jul 1;25(2):110-3.
33. Sihota R, Angmo D, Ramaswamy D, Dada T. Simplifying “target” intraocular pressure for different stages of primary open-angle glaucoma and primary angle-closure glaucoma. Indian journal of ophthalmology. 2018 Apr 1;66(4):495-505.
34. Kumar M, Parveen S, Chauhan L. Midterm outcome of single scleral suture technique in trabeculectomy and phacotrabeculectomy: a simplified approach. Therapeutic Advances in Ophthalmology. 2019 Jun;11:2515841419854829.
35. Olawoye O, Kizor-Akaraiwe N, Pons J, Sarimiye T, Washaya J, Hughes S, Ashaye A, Garba F, Gessesse GW, Chitedze R, Ibanga A. Clinical characteristics and stage at presentation of glaucoma patients in sub-Saharan Africa. Journal of Glaucoma. 2022 Sep 1;31(9):717-23.
36. Tsegaye M, Mulugeta A, Giorgis AT. Glaucoma awareness and knowledge among adults in Woliso town, South West Ethiopia. Journal of Clinical Research and Ophthalmology. 2020 Aug 6;7(2):087-90.
37. Shah M, Cabrera-Ghayouri S, Christie LA, Held KS, Viswanath V. Translational preclinical pharmacologic disease models for ophthalmic drug development. Pharmaceutical research. 2019 Apr;36(4):58.
38. Naik GT, Achar P, Kripalini SH, Sajjan S. A descriptive study on visual outcome and intraocular pressure control after trabeculectomy with manual small incision cataract surgery in patients with glaucoma and cataract. Journal of Pharmacy and Bioallied Sciences. 2022 Jul 1;14(Suppl 1):S654-7.
39. Majstruk L, Leray B, Bouillot A, Michée S, Sultan G, Baudouin C, Labbé A. Long-term effect of phacoemulsification on intraocular pressure in patients with medically controlled primary open-angle glaucoma. BMC Ophthalmology. 2019 Dec;19:1-7.
40. Tyagi R, Bhalla V. Preparation and evaluation of rebamipide ophthalmic nanosuspension for dry eye therapy. Int J Drug Deliv Technol. 2024;14(2):644-8. doi: 10.25258/ijddt.14.2.05.
2. Soh Z, Yu M, Betzler BK, Majithia S, Thakur S, Tham YC, Wong TY, Aung T, Friedman DS, Cheng CY. The global extent of undetected glaucoma in adults: a systematic review and meta-analysis. Ophthalmology. 2021 Oct 1;128(10):1393-404.
3. Kung JS, Choi DY, Cheema AS, Singh K. Cataract surgery in the glaucoma patient. Middle East African journal of ophthalmology. 2015 Jan 1;22(1):10-7.
4. Daba KT, Molla JM, Alemu TA. Assessment of risk factors for advanced open-angle glaucoma presentation among patients visiting Jimma University Medical Center, Jimma, Ethiopia. Ethiopian Journal of Health Sciences. 2022 Sep 20;32(5):929-36.
5. Chaves MA, De Medeiros AL, Vilar CM, Magalhães KR, Goncalves MR, de Moraes Tzelikis PF, Hida WT, Carricondo PC, Alves MR. Architecture evaluation of the main clear corneal incisions in femtosecond laser-assisted cataract surgery by optical coherence tomography imaging. Clinical Ophthalmology (Auckland, NZ). 2019 Feb 14;13:365.
6. Lee RY, Chen RI, Kasuga T, Cui QN, Porco TC, Lin SC. The effect of cumulative dissipated energy on changes in intraocular pressure after uncomplicated cataract surgery by phacoemulsification. Journal of Glaucoma. 2016 Jul 1;25(7):565-70.
7. Bamashmus MA, Al-Hamdi IM, Al-Hemyari MS, Al-Akhlee HA. Visual and Surgical Outcomes of Primary Phacotrabeculectomy with Mitomycin C in Patients with Open Angle and Pseudoexfoliative Glaucoma in Sana’a (Yemen). Yemeni Journal of Medical and Health Research. 2021;10(1&2).
8. Demir AG, Olgun A, Guven D, Demir M, Sendul SY, Akarsu Acar OP, Kacar H. The effect of combined phaco-trabeculectomy, trabeculectomy, and phacoemulsification on the corneal endothelium in the early stage: a preliminary study. International ophthalmology. 2019 Sep;39:2121-8.
9. Jiménez-Román J, Prado-Larrea C, Laneri-Pusineri L, Gonzalez-Salinas R. Combined glaucoma and cataract: an overview. Difficulties in cataract surgery. 2018 Jun 13:79-89.
10. Singh K, Misbah A, Saluja P, Singh AK. Review of manual small-incision cataract surgery. Indian journal of ophthalmology. 2017 Dec 1;65(12):1281-8.
11. Koike KJ, Chang PT. Trabeculectomy: a brief history and review of current trends. International ophthalmology clinics. 2018 Jul 1;58(3):117-33.
12. Grzybowski A, Kanclerz P. Recent developments in cataract surgery. Current concepts in ophthalmology. 2019 Oct 31:55-97.
13. Kyari F, Adekoya B, Abdull MM, Mohammed AS, Garba F. The current status of glaucoma and glaucoma care in sub-Saharan Africa. Asia-Pacific journal of ophthalmology. 2018 Nov 1;7(6):375-86.
14. Khan L, Verma S. Modified small-incision cataract surgery for combined extraction–A comparative study of two techniques. Indian Journal of Ophthalmology. 2022 Nov 1;70(11):3918-22.
15. Gore V, Agrawal MR, Choudhary A, Alex J, Shah A. A Study on Measurement of Central Corneal Thickness Changes in the Postoperative Period of Phacoemulsification Cataract Surgery. TNOA Journal of Ophthalmic Science and Research. 2021 Oct 1;59(4):364-7.
16. Bonnet C, Al-Hashimi S, Brézin AP, Monnet D. Femto Laser-Assisted Cataract Surgery. In Eyesight and Imaging-Advances and New Perspectives 2020 Oct 14. IntechOpen.
17. Yalçınkaya G, Altan C, Çakmak S, Başarır B, Alagöz N, Solmaz B, Paşaoğlu I. Effect of phacoemulsification surgery on intraocular pressure and function of bleb after trabeculectomy. International Ophthalmology. 2021 Jan;41:185-93.
18. Ianchulev T, Ahmed II, Stamper RL, Chang DF, Samuelson TW, Lindstrom RL. Innovative alternatives in the surgical management of glaucoma with cataract surgery. Expert Review of Ophthalmology. 2017 Sep 3;12(5):403-19.
19. Benítez Martínez M, Baeza Moyano D, González-Lezcano RA. Phacoemulsification: Proposals for improvement in its application. In Healthcare 2021 Nov 22 (Vol. 9, No. 11, p. 1603). MDPI.
20. Andini EA, Avianty A, Herman H, Choliq A. Efficacy and Safety of Manual Small-Incision Cataract Surgery With Trabeculectomy Versus Phacotrabeculectomy in Patients With Glaucoma and Cataract: A Systematic Review and Meta-Analysis. Cureus. 2023 Dec 24;15(12).
21. Jacob JM, Jacob AD, Goudinho S. The effect of manual small incision cataract surgery on the intraocular pressure− A prospective study in south Kerala. Indian J Clin Exp Ophthalmol. 2018 Jul;4(3):409-12.
22. Venkatesh R, Annamalai O, Robin AL. Managing Cataract and Glaucoma in the Developing World: Manual Small Incision Cataract Surgery (MSICS) Combined with Trabeculectomy. In Cataract Surgery in the Glaucoma Patient 2025 Feb 7 (pp. 115-128). Cham: Springer Nature Switzerland.
23. Yang SA, Ciociola EC, Mitchell W, Hall N, Lorch AC, Miller JW, Friedman DS, Boland MV, Elze T, Zebardast N, Pershing S. Effectiveness of microinvasive glaucoma surgery in the United States: intelligent research in sight registry analysis 2013–2019. Ophthalmology. 2023 Mar 1;130(3):242-55.
24. Richter GM, Coleman AL. Minimally invasive glaucoma surgery: current status and prospects. Clinical ophthalmology. 2016 Jan 28:189-206.
25. Amaral DC, Guedes J, de Oliveira Caneca K, Pereira SF, Alves MR, Manso JE, Ribeiro Monteiro ML, Louzada RN. Manual small incision cataract surgery combined with trabeculectomy versus phacoemulsification combined with trabeculectomy for coexisting glaucoma and cataract: a systematic review and meta-analysis. Expert Review of Ophthalmology. 2024 Jul 3;19(4):281-9.
26. Giorgis AT, Worku A. Outcomes of Combined Manual Small Incision Cataract Surgery and Trabeculectomy. Ethiopian Medical Journal. 2019 Jun 28;57(3).
27. Ramjee P, Sachdeva B, Golechha S, Kulkarni S, Fulari G, Murali K, Jain M. CataractBot: an LLM-powered expert-in-the-loop chatbot for cataract patients. arXiv preprint arXiv:2402.04620. 2024 Feb 7.
28. Guedes J, Pereira SF, Amaral DC, Hespanhol LC, Faneli AC, Oliveira RD, Mora-Paez DJ, Fontes BM. Phaco-chop versus divide-and-conquer in patients who underwent cataract surgery: a systematic review and meta-analysis. Clinical Ophthalmology. 2024 Dec 31:1535-46.
29. Khandelwal RR, Raje D, Rathi A, Agashe A, Majumdar M, Khandelwal R. Surgical outcome of safe surgery system trabeculectomy combined with cataract extraction. Eye. 2015 Mar;29(3):363-70.
30. Marchini G, Ceruti P, Vizzari G, Berzaghi D, Zampieri A. Management of concomitant cataract and glaucoma. Developments in Ophthalmology. 2017 Apr 25;59:155-64.
31. Rao A, Cruz RD. Cataract versus combined surgery in pseudoexfoliation glaucoma. Indian Journal of Ophthalmology. 2023 Mar 1;71(3):797-802.
32. Ndife TI, Abdullahi SM, Raji L, Umar MM, Olaniyi S, Alhassan MB. Long-term outcome of Trabeculectomy with and without small incision cataract surgery at a tertiary eye hospital in Northern Nigeria. Nigerian Journal of Ophthalmology. 2017 Jul 1;25(2):110-3.
33. Sihota R, Angmo D, Ramaswamy D, Dada T. Simplifying “target” intraocular pressure for different stages of primary open-angle glaucoma and primary angle-closure glaucoma. Indian journal of ophthalmology. 2018 Apr 1;66(4):495-505.
34. Kumar M, Parveen S, Chauhan L. Midterm outcome of single scleral suture technique in trabeculectomy and phacotrabeculectomy: a simplified approach. Therapeutic Advances in Ophthalmology. 2019 Jun;11:2515841419854829.
35. Olawoye O, Kizor-Akaraiwe N, Pons J, Sarimiye T, Washaya J, Hughes S, Ashaye A, Garba F, Gessesse GW, Chitedze R, Ibanga A. Clinical characteristics and stage at presentation of glaucoma patients in sub-Saharan Africa. Journal of Glaucoma. 2022 Sep 1;31(9):717-23.
36. Tsegaye M, Mulugeta A, Giorgis AT. Glaucoma awareness and knowledge among adults in Woliso town, South West Ethiopia. Journal of Clinical Research and Ophthalmology. 2020 Aug 6;7(2):087-90.
37. Shah M, Cabrera-Ghayouri S, Christie LA, Held KS, Viswanath V. Translational preclinical pharmacologic disease models for ophthalmic drug development. Pharmaceutical research. 2019 Apr;36(4):58.
38. Naik GT, Achar P, Kripalini SH, Sajjan S. A descriptive study on visual outcome and intraocular pressure control after trabeculectomy with manual small incision cataract surgery in patients with glaucoma and cataract. Journal of Pharmacy and Bioallied Sciences. 2022 Jul 1;14(Suppl 1):S654-7.
39. Majstruk L, Leray B, Bouillot A, Michée S, Sultan G, Baudouin C, Labbé A. Long-term effect of phacoemulsification on intraocular pressure in patients with medically controlled primary open-angle glaucoma. BMC Ophthalmology. 2019 Dec;19:1-7.
40. Tyagi R, Bhalla V. Preparation and evaluation of rebamipide ophthalmic nanosuspension for dry eye therapy. Int J Drug Deliv Technol. 2024;14(2):644-8. doi: 10.25258/ijddt.14.2.05.
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Jan 22, 2025
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Dr Sunny Wadhwani, Dr Shobha Marewar, & Dr Samiksha Karampuri. (2025). TO STUDY THE OUTCOMES OF SMALL INCISION CATARACT SURGERY AND TRABECULECTOMY (COMBINED SURGERY) AT GMC AKOLA. Journal of Population Therapeutics and Clinical Pharmacology, 32(1), 1599-1610. https://doi.org/10.53555/60gtpa76
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Author Biographies
Dr Sunny Wadhwani
Assistant professor Ophthalmology, Dept of Ophthalmology GMC Akola, Maharashtra
Dr Shobha Marewar
Assistant professor Ophthalmology, GMC Akola, Maharashtra
Dr Samiksha Karampuri
Junior resident Ophthalmology, GMC Akola, Maharashtra
How to Cite
Dr Sunny Wadhwani, Dr Shobha Marewar, & Dr Samiksha Karampuri. (2025). TO STUDY THE OUTCOMES OF SMALL INCISION CATARACT SURGERY AND TRABECULECTOMY (COMBINED SURGERY) AT GMC AKOLA. Journal of Population Therapeutics and Clinical Pharmacology, 32(1), 1599-1610. https://doi.org/10.53555/60gtpa76