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PR Cotran, S Roh; One-site vs. Two-site Phacotrabeculectomy: Results After One Year of Follow-up . Invest. Ophthalmol. Vis. Sci. 2002;43(13):3358.
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Purpose:To determine if a one-site or a two-site combined phaco/IOL and trabeculectomy surgery is superior in controlling intraocular pressure (IOP)or in other measures of clinical outcome. Methods: 73 consecutive eyes of 67 patients were prospectively randomized to either a one-site or a two-site phacotrabeculectomy with mitomycin C. In the one-site surgery a superior fornix-based incision was used for both the phaco/IOL and trabeculectomy.In the two-site surgery a temporal clear cornea phaco/IOL procedure was combined with a superonasal limbus-based trabeculectomy. Results:39 eyes randomized to the one-site procedure, and 34 eyes to the two-site procedure. The ages of the patients averaged 76 and 74 years in the two groups. The pre-op IOP in the one site group was a mean 21 mmHg on a mean of 2.3 glaucoma medications, and in the two-site group it was a mean of 19mmHg on a mean of 2.6 medications. At 12 months of follow-up the one-site group had a mean IOP of 12.6 on a mean of 0.7 medications, and the two-site group had a mean IOP of 12.4 on a mean of 0.19 medications. There was no difference between the two groups in the post-op IOP at one year (p=0.85), but the difference in mean medication requirement was significant (p=0.05). Mean decimal visual acuity was slightly better pre-op in the one-site group (0.35 vs. 0.27, p=0.05) but the mean visual acuity at three months follow-up was slightly better in the two-site group (0.69 vs. 0.81, p=0.04). Average total OR time was significantly longer in the two-site group (87 min. vs. 64 min., p=0.0001). Conclusion: In eyes needing both cataract and glaucoma surgery, both one-site and two-site phacotrabeculectomy are effective in lowering IOP and improving vision. At one year of follow-up the two-site eyes required, on average, fewer medications, suggesting that the two-site operation provides superior long term IOP control.
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