COMPARATIVE-STUDY OF SILICONE VERSUS ACRYLIC FOLDABLE LENS IMPLANTATION IN PRIMARY GLAUCOMA TRIPLE PROCEDURE

Objective: To compare silicone versus acrylic foldable intraocular len s (IOL) implantation in primary glaucoma triple procedure (PGTP). Desi gn: Prospective, randomized. Participants: A total of 79 eyes of 79 pr imary open-angle glaucoma (POAG) patients in need of combined surgery were randomized to a silicone IOL group (36 eyes) and acrylic IOL grou p (43 eyes). Intervention: The study eyes underwent PGTP, which consis ted of primary trabeculectomy, phacoemulsification, and posterior cham ber IOL implantation. Adjunctive mitomycin C (MMC) (0.5 mg/ml for 1 mi nute) was used selectively only in patients with one or more risk fact ors for filtration failure of PGTP. Main Outcome Measures: Snellen vis ual acuity, intraocular pressure (IOP), slit-lamp biomicroscopy, and n umber of glaucoma medications were measured, performed, or determined preoperatively and at regular intervals postoperatively. Results: Ther e were no significant differences in the mean number of postoperative glaucoma medications at 1, 2, 3, 4-6, and 9-12 months and at last foll ow-up (P > 0.05); mean change in corrected visual acuity best attained (P = 0.315) or at last followup (P = 0.223) between the silicone and acrylic groups. Both groups had significant decreases in mean IOP and mean number of medications postoperatively at all times (P < 0.05). Ho wever, the postoperative IOP > 25 mmHg and IOP spike > 5 mmHg above pr eoperative IOP during the first month were significantly higher in the acrylic group (P = 0.026). The mean postoperative IOP at 1 month in t he acrylic group was also significantly higher than the silicone group (14.1 +/- 5.0, 11.2 +/- 3.9, P = 0.005). Conversely, there were no si gnificant differences in mean postoperative IOP at 2, 3, 4-6, and 9-12 months and at last follow-up between the silicone and acrylic groups (P > 0.05). Suture removal or release occurred significantly more freq uently in the acrylic IOL group during the first month and the first 2 months (48.8% and 60.5%) than the silicone group (25.0% and 36.1%, P = 0.030 and 0.031, respectively). There were no significant difference s in postoperative complications or surgical interventions between the two groups (P > 0.05). Conclusions: During the first year following t he PGTP with selective use of MMC, there were no significant differenc es in the medical dependency or visual outcomes or complications betwe en the silicone and acrylic groups. Both groups attained significant d ecreases in IOP postoperatively. However, the mean IOP was significant ly higher in the acrylic than the silicone group at 1 month postoperat ively, and postoperative IOP > 25 mmHg and IOP spike > 5 mmHg above pr eoperative IOP were significantly greater in the acrylic group. There were significantly more suture releases in the acrylic IOL group than the silicone IOL group in the first 2 months postoperatively.