Patients’ experiences of remote communication after pacemaker implant

Abstract Background the concept of 'patient experience' has become central to how to improve healthcare. Remote communication with patients is today a frequent practice in healthcare services, showing similar outcomes to conventional monitoring at the hospital (CM) while enabling cost reduction in both formal and informal care. The purpose of this study was to analyse the experiences of people with remote monitoring (RM) of pacemakers. Methods Patients were randomly allocated to either the RM or CM. Using the 'Generic Short Patient Experiences Questionnaire' (GS-PEQ), as well as an ad-hoc survey from the 'telehealth patient satisfaction survey' and 'costs survey', patients' experiences were measured six months after the pacemaker implant in a cohort of 50 consecutive patients. The mean age was 74.8 (±11.75) years and 26 (52%) patients were male of which 1 was lost in follow-up. Differences in baseline characteristics between groups were not found. Results Findings showed overall positive and similar experiences in patients in both groups. Significant differences were found in GS-PEQ concerning how RM patients received less information about their diagnosis/ afflictions (p = 0.046). We did not find significant differences in other items such as 'confidence in the clinicians' professional skills', 'treatment perception adapted to their situation', 'involvement in decisions regarding the treatment', 'perception of hospital organisation', waiting before admission', 'satisfaction of help and treatment received', 'benefit received', and 'incorrect treatment'. Conclusions The remote communication of pacemakers was met with positive levels of patients' experiences similarly to patients in the CM group. However, patients included in RM group received less information. Thus, improving the quality and timing of information is required in RM group in the planning and organisation of future remote communication healthcare services for people living with a pacemaker implant. Key messages Patients included in both groups of follow-up showed similar levels in their experiences with the use of the pacemakers. It is necessary improving the quality and timing of information required in remote monitoring of users in the planning of future remote communication healthcare services for people with pacemaker.

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A non-randomized clinical trial to examine patients’ experiences and communication during telemonitoring of pacemakers after five years follow-up

PLoS ONE ◽

10.1371/journal.pone.0261158 ◽

2021 ◽

Vol 16 (12) ◽

pp. e0261158

Author(s):

Daniel Catalan-Matamoros ◽

Antonio Lopez-Villegas ◽

Cesar Leal Costa ◽

Rafael Bautista-Mesa ◽

Emilio Robles-Musso ◽

...

Keyword(s):

Clinical Trial ◽

Ad Hoc ◽

Healthcare Professionals ◽

Patient Experiences ◽

Negative Experiences ◽

Patient Satisfaction Survey ◽

Adequate Information ◽

Healthcare Communication ◽

Baseline Characteristics

Patients with pacemakers need regular follow-ups which are demanding. Telemonitoring for pacemaker can provide a new opportunity to avoid follow-up visits. On the other hand, in-person visits could help patients with pacemakers to cope better with the anxiety linked to their condition and maintain better communication with their doctors than simple remote control of their device status. Therefore, our objective was to analyze the experiences and communication comparing telemonitoring (TM) versus conventional monitoring (CM) of patients with pacemakers. A single-center, controlled, non-randomized, non-blinded clinical trial was designed. Data were collected five years after implantation in a cohort of 89 consecutive patients assigned to two different groups: TM and CM. The ‘Generic Short Patient Experiences Questionnaire’ (GS-PEQ) was used to assess patients’ experiences, and the Healthcare Communication Questionnaire (HCCQ) was used to measure the communication of patients with healthcare professionals. Additionally, an ad-hoc survey including items from the ‘Telehealth Patient Satisfaction Survey’ and a ‘costs survey’ was used. After five years, 55 patients completed the study (TM = 21; CM = 34). Participants’ mean (±SD) age was 81 (±6.47), and 31% were females. No differences in baseline characteristics between groups were found. The comparative analyses TM versus CM showed some significant differences. According to GS-PEQ, TM users received adequate information about their diagnosis or afflictions (p = .035) and the treatment was better adapted to their situation (p = .009). Both groups reported negative experiences regarding their involvement in their treatment decisions, the waiting time before admission, and perceived a low-benefit. According to HCCQ, the TM group experienced poorer consultation management by the healthcare provider (p = .041). Participants reported positive overall communication experiences. The study provides insights into the experiences and communication in PM monitoring services as well as specific areas where users reported negative experiences such as the consultation management by clinicians. Trial registration: ClinicalTrials.gov NCT02234245.

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Assessing Communication during Remote Follow-Up of Users with Pacemakers in Norway: The NORDLAND Study, a Randomized Trial

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17207678 ◽

2020 ◽

Vol 17 (20) ◽

pp. 7678

Author(s):

Daniel Catalan-Matamoros ◽

Antonio Lopez-Villegas ◽

Knut Tore Lappegård ◽

Remedios Lopez-Liria

Keyword(s):

Remote Monitoring ◽

Healthcare Services ◽

Models Of Care ◽

Patient Centered ◽

Remote Communication ◽

Quality Healthcare ◽

Centered Care ◽

Observational Design ◽

Depth Interviews

As effective communication is a key ingredient for the provision of quality healthcare services, this study aimed to explore the communication experiences in the remote monitoring of older adults with a pacemaker. The study was based on a non-masked randomized observational design. The Healthcare Communication Questionnaire and in-depth interviews were conducted for data collection. A total of 49 patients participated in the study. The study findings reveal overall positive communication experiences by pacemaker users in remote monitoring with no significant differences from users in hospital monitoring. The remote option is perceived as safe and convenient, and communicating with the clinicians from home is considered comfortable and confidential. The study provides insights into the content of communication experiences in telehealth and practical implications in healthcare contexts. In a world that increasingly relies on remote communication, it is crucial to match technologies to patient needs and assess communication with patients. This will ensure the success of new models of care and establish appropriate criteria for the use of telehealth services. These criteria are all relevant in the implementation of health technology in the future as a part of effective patient-centered care.

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Real-world effectiveness of app-based treatment for urinary incontinence: a cohort study

BMJ Open ◽

10.1136/bmjopen-2020-040819 ◽

2021 ◽

Vol 11 (1) ◽

pp. e040819

Author(s):

Pontus Rygh ◽

Ina Asklund ◽

Eva Samuelsson

Keyword(s):

Urinary Incontinence ◽

Cohort Study ◽

Real World ◽

Short Form ◽

Pelvic Floor Muscle ◽

Controlled Trial ◽

Healthcare Services ◽

International Consultation ◽

The Mean

ObjectivesThe efficacy of app-based treatment for stress urinary incontinence (SUI) has been demonstrated in a randomised controlled trial (RCT). In this study, we investigate the user characteristics and the effectiveness of the same app when freely available, and compare these results with the RCT.DesignProspective cohort study.ParticipantsDuring a 17-month period, 24 602 non-pregnant, non-postpartum women older than 18 years downloaded the app and responded anonymously to a questionnaire. Of these, 2672 (11%) responded to the 3-month follow-up.InterventionThree months’ use of the app Tät, containing information, a pelvic floor muscle training programme and lifestyle advice.Main outcome measuresChange in symptom severity (International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF)) and subjective improvement (Patient Global Impression of Improvement (PGI-I)).ResultsOf the respondents, 88% lived in Sweden and 75% (18 384/24 602) were incontinent with a mean age of 45.5 (SD 14.1) years. The UI types, based on symptoms, were SUI (53%), urgency UI (12%), mixed UI (31%) and undefined (4%). The mean ICIQ-UI SF score was 8.2 (SD 4.0) at baseline. The mean ICIQ-UI SF score reduction at follow-up was 1.31 (95% CI: 1.19 to 1.44) with a larger reduction in those with more severe incontinence at baseline (severe/very severe 3.23 (95% CI: 2.85 to 3.61), moderate 1.41 (95% CI: 1.24 to 1.59) and slight 0.24 (95% CI 0.06 to 0.42). When the results were weighted to match the distribution of severity in the RCT, the ICIQ-UI SF score reduction was 2.2 compared with 3.9 in the RCT. Regarding PGI-I, 65% experienced improvement compared with 92% in the RCT.ConclusionsThe app Tät was effective for self-management of UI even in the real world. Although the reduction in incontinence symptoms was less than in the RCT, two-thirds of the users improved. App-based treatment reaches many women without requiring resources from ordinary healthcare services.

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Bariatric surgery in patients with type 1 diabetes: special considerations are warranted

Therapeutic Advances in Endocrinology and Metabolism ◽

10.1177/2042018818822207 ◽

2019 ◽

Vol 10 ◽

pp. 204201881882220 ◽

Cited By ~ 5

Author(s):

Zohar Landau ◽

Galit Kowen-Sandbank ◽

Daniela Jakubowicz ◽

Asnat Raziel ◽

Nasser Sakran ◽

...

Keyword(s):

Bariatric Surgery ◽

Type 1 Diabetes ◽

Diabetic Ketoacidosis ◽

Glucose Control ◽

Healthcare Services ◽

Short And Long Term ◽

The Mean

Objective: We examined short and long-term outcomes of bariatric surgery in patients with obesity and type 1 diabetes mellitus (T1DM). Methods: We reviewed the records of all adults insured by Maccabi Healthcare Services during 2010 -2015, with body mass index (BMI) ⩾30 kg/m2 and T1DM; and compared weight reduction and glucose control according to the performance of bariatric surgery. BMI and glycated hemoglobin (HbA1c) levels were extracted for baseline and every 6 months, for a mean 3.5 years. Results: Of 52 patients, 26(50%) underwent bariatric surgery. Those who underwent surgery were more often female and with a longer duration of diabetes. Immediately postoperative, 4(15%) developed diabetic ketoacidosis, while 6(23%) experienced severe hypoglycemic episodes. The mean BMI decreased among surgery patients: from 39.5±4.4 to 30.1±5.0 kg/m2 ( p < 0.0001); and increased among those who did not undergo surgery: from 33.6±3.9 to 35.1±4.4 kg/m2 ( p = 0.49). The mean HbA1c level decreased during the first 6 months postoperative: from 8.5±0.9% to 7.9±0.9%; however, at the end of follow-up, was similar to baseline, 8.6±2.0% (p = 0.87). For patients who did not undergo surgery, the mean HbA1c increased from 7.9±1.9% to 8.6±1.5% ( p = 0.09). Conclusions: Among individuals with obesity and T1DM, weight loss was successful after bariatric surgery, but glucose control did not improve. The postoperative risks of diabetic ketoacidosis and severe hypoglycemic episodes should be considering when performing bariatric surgery in this population.

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A Randomised Controlled Trail of Plasma Exchange in Rapidly Progressive Renal Failure of Myeloma.

Blood ◽

10.1182/blood.v104.11.4899.4899 ◽

2004 ◽

Vol 104 (11) ◽

pp. 4899-4899

Author(s):

William F. Clark ◽

A. Keith Stewart ◽

Gail A. Rock ◽

Marion Sternbach ◽

David M. Sutton ◽

...

Keyword(s):

Serum Creatinine ◽

Sample Size ◽

Plasma Exchange ◽

Kidney Failure ◽

Statistical Significance ◽

Control Group ◽

Significant Difference ◽

The Mean ◽

Baseline Characteristics

Abstract In myeloma, plasma exchange (PE) has been suggested to prevent rapidly progressive kidney failure by reducing exposure to nephrotoxic light chains. We carried out a randomized controlled multi-centre trial comparing PE or no PE in 104 patients of whom 101 met the inclusion, exclusion criteria and 4 were lost to follow-up. We compared baseline characteristics as well as renal outcomes and performed a futility analysis to determine the sample size necessary for potential statistical significance for the changes noted. Thirty-nine patients were randomized to the control group and 58 to the PE group with a 6-month follow-up. The baseline characteristics of these 2 groups were similar including serum creatinine, dialysis dependence, age, gender, serum calcium, serum albumin, 24 -hour urine for protein levels and Durie-Salmon myeloma staging. Thirteen (33.3%) of the control group and 19 (33.3%) of the PE group died within 6 months of follow up. Ten patients (31%) in the control and 10 patients (21%) in the PE arm were dialysis dependent at 6 months. Seven patients (47%) came off dialysis in the control and 13 patients (59%) in the PE arm with the mean number of dialysis days from 0–6 months being 45.7±67.6 in the control versus 29.2±56.1 in the PE arm at 6 months. The mean serum creatinine in the control group was 314.6±256.1 μmol/L versus 215.4±215.3 μmol/L in the PE group and the composite end point of death, dialysis or serum creatinine >254 μmol/L occurred in 12 (30.8%) in the control and 11 (19.3%) in the PE arm. The futility analysis to indicate the per group sample size necessary to achieve statistical significance at 6 months for the difference we observed was infinite for cumulative mortality, 805 for dialysis dependence, 2418 for coming off dialysis, 321 for number of dialysis days, 132 for creatinine difference of 100 μmol/L and for the composite outcome of death, dialysis or creatinine>354 μmol/L, 737. We did not observe a statistically significant difference in mortality or renal morbidity for PE versus no PE in patients with myeloma and rapidly progressive kidney failure.

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Benefit of Ambulatory Management of Patients with Chronic Heart Failure by Protocolized Follow-Up Therapeutic Education and Remote Monitoring Solution: An Original Study in 159 Patients

Journal of Clinical Medicine ◽

10.3390/jcm9103106 ◽

2020 ◽

Vol 9 (10) ◽

pp. 3106

Author(s):

Anne Jenneve ◽

Noel Lorenzo-Villalba ◽

Guy Courdier ◽

Samy Talha ◽

François Séverac ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Education Program ◽

Remote Monitoring ◽

Therapeutic Education ◽

Left Ventricular Ejection ◽

The Mean ◽

One Year ◽

Heart Condition

This study sought to determine whether the implementation of regular and structured follow-up of patients with chronic heart failure (CHF), combined with therapeutic education and remote monitoring solution, leads to better management. This was a single-center retrospective study conducted in a cohort of patients with proven CHF who were followed up in the Mulhouse region (France) between January 2016 and December 2017 by the Unité de Suivi des Patients Insuffisants Cardiaques (USICAR) unit. These patients received regular protocolized follow-up, a therapeutic education program, and several used a telemedicine platform for a two-year period. The primary endpoint was the number of days hospitalized for heart failure (HF) per patient per year. The main secondary endpoints included the number of days hospitalized for a heart condition other than HF and the number of hospital stays for HF per patient. These endpoints were collected during the year preceding enrollment, at one year of follow-up, and at two years of follow-up. The remote monitoring solution was evaluated on the same criterion. Overall, 159 patients with a mean age of 72.9 years were included in this study. They all had CHF, mainly NYHA Class I-II (88.7%), predominantly of ischemic origin (50.9%), and with altered left ventricular ejection fraction in 69.2% of cases. The mean number of days hospitalized for HF per patient per year was 8.33 (6.84–10.13) in the year preceding enrollment, 2.6 (1.51–4.47) at one year of follow-up, and 2.82 at two years of follow-up (1.30–6.11) (p < 0.01 for both comparisons). The mean number of days hospitalized for a heart condition other than HF was 1.73 (1.16–2.6), 1.81 (1.04–3.16), and 1.32 (0.57–3.08), respectively (p = ns). The percentage of hospitalization for HF for each patient was 69.5% (60.2–77.4), 16.2% (10–25.2), and 19.3% (11–31.8), respectively (p < 0.001 for both comparisons). In the group telemedicine, the mean number of days hospitalized for HF per patient per year was 8.33 during the year preceding enrollment, 2.3 during the first year of follow-up, and 1.7 during the second. This difference was significant (p < 0.001). The “number of days hospitalized for a heart condition other than HF” was significantly reduced in the group of patient’s beneficiating from the remote monitoring solution. This study demonstrates the value of a protocolized follow-up associated with a therapeutic optimization, therapeutic education program, and the use of a remote monitoring solution to improve the management of ambulatory patients with CHF, particularly of moderate severity.

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P994Does AF always beget AF? Retrospective study in patients with complex cardiac devices

EP Europace ◽

10.1093/europace/euaa162.170 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

A Briosa E Gala ◽

M Pope ◽

M Leo ◽

T R Betts

Keyword(s):

Retrospective Study ◽

Remote Monitoring ◽

Binary Classification ◽

Statistical Significance ◽

First Episode ◽

Cardiac Devices ◽

Direct Current Cardioversion ◽

Number Of Patients ◽

The Mean

Abstract Introduction Atrial fibrillation (AF) is conventionally divided in paroxysmal AF (PAF) and persistent AF (PersAF) according to episode duration, with a perceived inevitable progression of the arrhythmia in most patients: "AF begets AF". This dichotomous classification of AF is currently being challenged by continuous monitoring with implantable cardiac monitors and pacemakers which suggest different patterns of AF with considerable variation in AF burden. Purpose This study sought to examine the long-term progression of AF burden in patients with complex cardiac devices (implantable cardiac defibrillators [ICD] and cardiac resynchronisation therapy-defibrillators [CRT-D]). Methods This retrospective study examined the weekly AF burden in patients with ICDs and CRT-Ds and on remote monitoring between January 2010 and July 2019. All transmissions and electrograms were assessed for the presence of AF lasting more than 6 minutes. The first episode of AF determined was considered follow-up year 0. PersAF was defined as a weekly AF burden of 100%. Medical records were reviewed for baseline characteristics at the time of the first episode of AF and interventions that may affect burden such as direct current cardioversion (DCCV) and catheter ablations. Results Of 331 patients on remote monitoring, 106 (32%) had evidence of AF. Of these, 89% were male, age 64 ± 12 years, BMI 30 ± 6 kg/m2, LA diameter 4.5 ± 0.8 cm, 58% had an ICD, 10% had previous AF ablation and 27% had antiarrhythmic medication. Forty-six (43%) had PersAF and 60 (57%) had PAF over a total follow-up of 393 patient years (mean follow-up 4.6. ±2.1). The mean AF burden was 1.2 ± 4.4% in PAF and 66.4 ± 35.3% in PersAF at the end of the first year of follow-up. When compared to year 1, the mean annual AF burden did not increase in the PAF and PersAF groups. Moreover, the PersAF patients had a significant reduction in the mean annual AF burden up to year 7 of follow-up. In year 8, the mean annual AF burden remained below year 1; however, due to a low number of patients (5) it did not reach statistical significance (mean difference 15.1%, p = 0.06) . To further assess individual progression in PersAF patients, the annual AF burden was subdivided in 4 categories (<25%, 25%-50%, 50%-75% and >75%). In 30 (65%) patients it remained unchanged, in 5(11%) it worsened and in 11 (24%) it improved (Figure ). Moreover, 35 (76%) patients reverted to sinus rhythm following their first episode of PersAF (5 following DCCV and 2 after catheter ablation). Conclusions In this cohort, the mean AF burden did not increase; in fact, we observed a significant reduction in patients with PersAF despite a low rate of interventions. These findings reinforce the emerging concept of AF as a heterogenous disease with various phenotypes that challenge the current simplistic binary classification. Abstract Figure

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Preoperative patient expectations and pain improvement after adult spinal deformity surgery

Journal of Neurosurgery Spine ◽

10.3171/2020.3.spine191311 ◽

2020 ◽

Vol 33 (4) ◽

pp. 496-501

Author(s):

Micheal Raad ◽

Andrew B. Harris ◽

Varun Puvanesarajah ◽

Mostafa H. El Dafrawy ◽

Floreana N. Kebaish ◽

...

Keyword(s):

Back Pain ◽

Pain Relief ◽

Adult Spinal Deformity ◽

High Expectations ◽

Patient Reported ◽

Low Expectations ◽

The Mean ◽

Baseline Characteristics ◽

Preoperative Expectations

OBJECTIVEPatients’ expectations for pain relief are associated with patient-reported outcomes after treatment, although this has not been examined in patients with adult spinal deformity (ASD). The aim of this study was to identify associations between patients’ preoperative expectations for pain relief after ASD surgery and patient-reported pain at the 2-year follow-up.METHODSThe authors analyzed surgically treated ASD patients at a single institution who completed a survey question about expectations for back pain relief. Five ordinal answer choices to “I expect my back pain to improve” were used to categorize patients as having low or high expectations. Back pain was measured using the 10-point numeric rating scale (NRS) and Scoliosis Research Society–22r (SRS-22r) patient survey. Preoperative and postoperative pain were compared using analysis of covariance.RESULTSOf 140 ASD patients eligible for 2-year follow-up, 105 patients (77 women) had pre- and postoperative data on patient expectations, 85 of whom had high expectations. The mean patient age was 59 ± 12 years, and 46 patients (44%) had undergone previous spine surgery. The high-expectations and low-expectations groups had similar baseline demographic and clinical characteristics (p > 0.05), except for lower SRS-22r mental health scores in those with low expectations. After controlling for baseline characteristics and mental health, the mean postoperative NRS score was significantly better (lower) in the high-expectations group (3.5 ± 3.5) than in the low-expectations group (5.4 ± 3.7) (p = 0.049). The mean postoperative SRS-22r pain score was significantly better (higher) in the high-expectations group (3.3 ± 1.1) than in the low-expectations group (2.6 ± 0.94) (p = 0.019).CONCLUSIONSDespite similar baseline characteristics, patients with high preoperative expectations for back pain relief reported less pain 2 years after ASD surgery than patients with low preoperative expectations.

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Patient-Reported Outcomes Following Multi-Ligament Knee Injuries With or Without Internal Brace Augmentation and the Role of Patient Access to Rehabilitation (174)

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00294 ◽

2021 ◽

Vol 9 (10_suppl5) ◽

pp. 2325967121S0029

Author(s):

Shane Korber ◽

Ioanna Bolia ◽

Neilan Benvergnu ◽

Brian Panish ◽

Tristan Juhan ◽

...

Keyword(s):

Patient Reported Outcomes ◽

Postoperative Outcomes ◽

Short Term ◽

Postoperative Rehabilitation ◽

Limited Access ◽

Patient Reported ◽

Internal Brace ◽

The Mean ◽

Baseline Characteristics

Objectives: (1) To compare the postoperative outcomes in patient who underwent multifilament knee reconstruction (MLKR) with or without internal brace augmentation and (2) To examine potential differences in outcomes of patients with different access to postoperative rehabilitation following MLKR. Methods: Adult patients sustaining a multifilament knee injury (MLKI) from 2007 to 2020 who were surgically treated by a single surgeon were retrospectively identified and invited to participate. Patients with incomplete follow up data were excluded. Data recorded included patient demographics, intraoperative procedure performed (with versus without use of internal brace), patient access to rehabilitation after surgery (limited versus full access) and postoperative patient reported outcomes. The last included the Multiligament Quality of Life Questionnaire (MLQOL), PROMIS Computer Adaptive Testing (CAT) for Physical Function, Mobility, and Pain Interference, and the Lysholm Knee Questionnaire. Descriptive statistics were conducted using STATA. Comparison of the postoperative outcomes was performed between patients who received or did not receive internal brace during MLKR and those who had limited versus full access to postoperative rehabilitation, using descriptive statistics (STATA). The level of statistical significance was set at <0.05. Results: A total of 85 (15 females,70 males) patients met the inclusion criteria. Of those, 62 patients (13 females, 49 males underwent MLKR without internal brace augmentation (NIB group) and 23 patients (2 females, 11 males) underwent MLKR with internal brace augmentation (IB group). Patient age and BMI were similar between the IB and NIB groups (Table 1). The mean follow-up time was 5.2+/-0.6 years on the NIB group and 1.5+/-0.1 years in the IB group (p<0.0001). The comparison of baseline characteristics and postoperative outcomes in MLKR patients in the NIB and IB groups is shown in Table 1. There was no difference in any of the postoperative outcome scores between patients in the NIB and IB groups who underwent MLKR. Access to rehabilitation data were available for 83 patients. Of those, 69 patients (12 females, 57 males) had full access to rehabilitation and 17 patients (3 females, 14 males) had limited access to postoperative rehabilitation. The mean follow- up time was similar between patients with versus limited access to rehabilitation (mean time was 2.6 years and 2.2 years respectively, p=0.96). The baseline patient characteristics were similar between the last two subgroups. However, patients with limited access to postoperative rehabilitation had significantly lower PROMIS Pain (p=0.018) and PROMIS Physical Function (p=0.025) scores compared to patients with full access to rehabilitation. The comparison of baseline characteristics and postoperative outcomes in MLKR patients with limited versus full access to postoperative rehabilitation is presented in Table 2. Conclusions: Internal bracing augmentation did not result in significant improvement of postoperative outcomes in patients undergoing MLKR, compared to the traditional technique without the use of internal brace, at short-term follow up. Postoperative rehabilitation is critical in patients who undergo MLKR, as patients with limited access to may experience worse outcomes at short term follow up in comparison to those who have full access to rehabilitation services. The socioeconomic status of the MLKR candidates should be examined preoperatively, and efforts should be made to grant these patients access to postoperative rehabilitation in order to optimize their clinical outcomes.

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Intraocular pressure control after combined phacotrabeculectomy versus trabeculectomy alone

European Journal of Ophthalmology ◽

10.1177/1120672121999997 ◽

2021 ◽

pp. 112067212199999

Author(s):

Matteo Sacchi ◽

Gianluca Monsellato ◽

Edoardo Villani ◽

Rosario Alfio Umberto Lizzio ◽

Elena Cremonesi ◽

...

Keyword(s):

Intraocular Pressure ◽

Success Rate ◽

Pressure Control ◽

High Dose ◽

Topical Steroids ◽

Success Rates ◽

Kaplan Meier ◽

The Mean ◽

Baseline Characteristics

Purpose: We compared the efficacy and safety of trabeculectomy and phacotrabeculectomy in patients with glaucoma. Materials and methods: We retrospectively analyzed consecutive patients who underwent trabeculectomy or phacotrabeculectomy. Patients in the trabeculectomy group were pseudophakic. We established three different intraocular pressure (IOP) thresholds (A: <21 mmHg, B: <18 mmHg, and C: <15 mmHg) to measure complete (without medication) and qualified (with medication) success. Success criteria were analyzed through Kaplan-Meier survival curves. Results: Sixty-seven eyes were included (40 trabeculectomy, 27 phacotrabeculectomy). The mean follow-up period was 25.70 ± 14.439 months. The baseline characteristics were similar between the groups. The complete and qualified success rates according to criterion C were significantly higher in the trabeculectomy group ( p = 0.033, p = 0.021, respectively); however, there was a trend toward a higher success rate for all criteria in favor of trabeculectomy. Bleb needling was more frequent in the phacotrabeculectomy group. The mean IOP significantly decreased from 26.46 ± 7.07 to 12.27 ± 4.06 at 12 months ( p < 0.001). The final mean IOP was significantly lower in the trabeculectomy than in the phacotrabeculectomy group (10.95 ± 3.08 vs 13.00 ± 4.56, p = 0.0003). Conclusion: In pseudophakic eyes, trabeculectomy alone achieves a higher success rate, lower mean IOP, and less frequent bleb needlings. More frequent follow-up and prolonged postoperative use of high-dose topical steroids should be considered in patients undergoing phacotrabeculectomy.

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