September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Comparison of Surgical Outcomes Between Combined Trabectome and Phacoemulsification vs. Combined Trabeculectomy and Phacoemulsification in Advanced Glaucoma
Author Affiliations & Notes
  • Julie You Kwon
    Department of Ophthalmology, North Shore Long Island Jewish Hospital, Great Neck, New York, United States
  • Dov Bechhofer
    Stony Brook University, East Setauket, New York, United States
  • Craig H Marcus
    Department of Ophthalmology, North Shore Long Island Jewish Hospital, Great Neck, New York, United States
  • Allison Angelilli
    Department of Ophthalmology, North Shore Long Island Jewish Hospital, Great Neck, New York, United States
  • Daniel Hayes
    Department of Ophthalmology, North Shore Long Island Jewish Hospital, Great Neck, New York, United States
  • Robert Rothman
    Department of Ophthalmology, North Shore Long Island Jewish Hospital, Great Neck, New York, United States
  • Footnotes
    Commercial Relationships   Julie Kwon, None; Dov Bechhofer, None; Craig Marcus, None; Allison Angelilli, None; Daniel Hayes, None; Robert Rothman, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 6519. doi:
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      Julie You Kwon, Dov Bechhofer, Craig H Marcus, Allison Angelilli, Daniel Hayes, Robert Rothman; Comparison of Surgical Outcomes Between Combined Trabectome and Phacoemulsification vs. Combined Trabeculectomy and Phacoemulsification in Advanced Glaucoma. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6519.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To compare operative outcomes of patients after combined trabectome and phacoemulsification vs. combined trabeculectomy and phacoemulsification in open angle glaucoma patients with visually significant cataracts

Methods : Retrospective review of patients with open angle glaucoma and visually significant cataracts who underwent either combined trabectome and phacoemulsification (n=39) versus combined trabeculectomy and phacoemulsification (n=24) from 2009 to 2014. Primary outcomes were intraocular pressure (IOP) and number of glaucoma medications over 6 month follow-up.

Results : The average pre-operative IOP in both groups were: Combined Trabectome Phaco group 17.4 +/- 5.1mmHg and Combined Trabeculectomy Phaco group was 17.4 +/- 8.9 mmHg (p=0.34). The mean IOP at 3 months and 6 months are: Trabectome Phaco group: 14.6 +/- 3.7mmHg, 15.0 +/- 3.2 mmHg; in Trabeculectomy Phaco group 11.1 +/- 3.7mmHg and 12.4 +/- 5.6 mmHg. The IOP dropped by 15% in Trabectome Phaco group at 3 months, and 12% at 6 months. The IOP decreased by 26% (p<0.01) in the Trabeculectomy Phaco group both at 3 months and at 6 months. The average pre-op glaucoma medication in the Trabectome Phaco group was 1.8 versus Trabeculectomy Phaco group was 3.36. By 6 months, glaucoma medications in the Trabeculectome Phaco group was reduced by 0.9 versus 2.6 in the Trabeculectomy Phaco group. In comparing post-operative visual acuity, 84.6% of Trabectome Phaco group achieved uncorrected VA of 20/40 or better within 1 month, compared to 54.0% of Trabeculectomy Phaco group. In the Trabeculectomy Phaco group, 50% of patients underwent at least one post-operative laser suture lysis within the first 3 months.

Conclusions : In patients with primary open angle glaucoma and visually significant cataract, combined phacoemulsification and trabectome or phacoemulsification and trabeculectomy decrease IOP and number of glaucoma medications in meaningful ways. Patients who underwent combined trabeculectomy and phaco achieved a more significant reduction in IOP and number of medications. However, more than half of trabeculectomy group required post-operative intervention and took longer time to achieve similar visual acuity than the trabectome group. Both combined procedures are effective in lowering IOP and number of medications, and may be tailored for severity of glaucoma.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

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