Abstract
Abstract: :
Purpose: To determine if a one–site or a two–site combined phaco/IOL and trabeculectomy is superior in long–term control of intraocular pressure (IOP) and in other clinical measures of outcome. Methods: This was a prospective, randomized study design. 87 eyes of 76 patients with visually significant cataract and glaucoma received either a one–site or a two–site phacotrabeculectomy with mitomycin C application for three minutes. In the one–site surgery a superior fornix–based conjunctival incision was used for both the phaco/IOL and trabeculectomy. In the two–site surgery a temporal clear corneal phaco/IOL procedure was combined with a superior trabeculectomy using a limbus–based conjunctival incision. Patients were followed for three years after surgery to evaluate IOP, need for glaucoma medications, and filtering bleb function. Results: 44 eyes randomized to the one–site procedure, and 43 eyes to the two–site procedure. The ages of the patients averaged 75.3 years in the one–site group and 76.1 years in the two–site group. Other patient characteristics were also similar. The preoperative IOP in the one–site group was a mean of 20.0 (mmHg) using a mean of 2.3 medications, and in the two–site group 19.5 on 2.5 medications. At 12 months of follow–up eyes in the one–site group had a mean IOP of 12.5 on a mean of 0.3 medications, and eyes in the two–site group had a mean IOP of 11.7 on a mean of 0.2 medications. The differences between the two groups at 12 months were not statistically significant. After 36 months of follow–up patients in the one–site group had a mean IOP of 12.9 using a mean of 0.4 medications while patients in the two–site group had a mean IOP of 11.8 on a mean of 0.6 medications. The differences between the two groups at 36 months were not statistically significant. At the 36 month follow–up visit, 76% of the one–site eyes were using no glaucoma medication, compared with 77% of the two–site eyes. Four patients in the one–site group and three patients in the two–site group had complications related to the trabeculectomy that required reoperation. One patient in the two–site group had a blebitis 30 months after surgery. Average operating time to perform the phacotrabeculectomy was longer in the two–site group. (87 minutes vs 64 minutes, p=0.0001). Conclusions: In patients requiring combined cataract and glaucoma surgery, one–site and two–site phacotrabeculectomy are equally effective in lowering IOP. After three years of follow–up both groups maintained excellent control of intraocular pressure with a marked reduction in the need for glaucoma medications.
Keywords: treatment outcomes of cataract surgery • clinical (human) or epidemiologic studies: outcomes/complications • small incision cataract surgery