Advanced open angle glaucoma with controlled intraocular pressure and cataract: one-year predictive model of glaucoma progression after surgical treatment.

Purpose To identify the predictive factors of midterm postoperative course in patients with visually significant cataract and advanced open angle glaucoma with intraocular pressure controlled on topical medications. Methods 55 patients with visually significant cataract and advanced open angle glaucoma (visual field Mean Deviation (MD)≤-12dB) and intraocular pressure(IOP)≤21mmHg on topical medications were prospectively studied(longitudinal data analysis).32 patients undergone phacoemulsification alone versus 23 patients undergoing combined phaco-trabeculectomy. Main outcome measures: IOP(mmHg), visual acuity(VA)(logMAR), MD(dB), number of antiglaucoma medications needed postoperatively. Follow-up 1 year. Results The combined surgery provided more IOP reduction (-5.76(-7 to -4.5) mmHg) (p<0.001) and allowed the reduction of antiglaucoma medications postop by 2.2(2.7 to 1.8) (p<0.001). VA improvement was more by the time elapsed (p=0.014) and preoperative MD (p=0.006) and less by the presence of relative afferent pupillary defect(RAPD)(p<0.001). The MD change was related to the preoperative MD (p<0.001) while Cup-Disc Ratio had a negative effect on postoperative MD change (p=0.001). The presence of RAPD reduced the MD change (p=0.052) while patients with pseudoexfoliation syndrome and women showed improvement in their MD postoperatively (p=0.038 and p=0.021, respectively). Conclusion type of operation is the main predictive factor of the IOP change and number of antiglaucoma medication reduction. VA improvement is related to severe damage of the optic nerve and visual field change is related to the degree of glaucomatous damage of the optic nerve.