Results of Combined Phacoemulsification and Trabeculectomy

Abstract

Abstract: : Purpose: In this prospective randomized study the efficacy and safety of one-site and two-site combined phacotrabeculectomy with foldable posterior chamber IOL implantation were compared. Methods: Patients with glaucoma and coexisting cataract (VA < 5 Snellen lines) were randomly assigned to undergo either a 1-site or 2-site combined procedure. Inclusion criteria for glaucoma were IOP < 28 mmHg under topical treatment and no previous surgery or laser trabeculoplasty application. One-site approach consisted of a standard superior phacotrabeculectomy with a fornix-based conjuctival flap, while two-site approach consisted of a clear cornea phaco and a separate superior trabeculectomy with limbus-based conjunctival flap. In all patients a foldable acrylic IOL was implanted in the capsular bag. Results: Forty-one eyes of 34 patients were included in the study. Follow-up ranged from 12 to 19 months. Mean preoperative IOP was in the 1-site group (22 eyes) 21.3 mm Hg +/- 2.8 (SD) and in the 2-site group (19 eyes) 21.8 +/- 3.0 mm Hg (p > 0.1). The number of preoperative glaucoma medications was similar in the two groups (1.8 +/- 0.91 and 2.1 +/- 1.03 respectively, p > 0.1). Postoperative IOP significantly decreased in both groups compared to the preoperative level but at the last follow-up (range 12 to 19 months), there was no statistically significant difference between the one-site and two-site groups. At last follow-up the 1-site group required significantly more medications than did the two-site group (p = 0.030). Best-corrected distance VA improved similarly in both groups but there was less postoperative (induced) astigmatism in the 2-site group in a marginal statistical level (p = 0.058). Intra- and post-operative complications were comparable in the two groups. Conclusions: Both techniques of phacotrabeculectomy used, yielded similar results in corrected visual acuity and in IOP reduction. However, the 2-site group had less induced astigmatism and a better postoperative IOP control with less required postoperative antiglaucoma medication compared to the 1-site group.

Keywords: clinical (human) or epidemiologic studies: tre • intraocular pressure • cataract