Abstract
Purpose :
To report long-term outcomes after combined cataract, lens implant and trabeculectomy surgeries performed by one surgeon with resident and glaucoma fellow participation from 1987 to late 2017.
Methods :
Combined cataract and trabeculectomy surgery was performed in 1867 eyes of 1394 patients over 31 years from 1987 to late 2017. Prospective data collected included age, race, gender, axial length and also included preoperative and postoperative visual acuity, intraocular pressure (IOP), glaucoma medication use and postoperative events and complications.
Results :
Mean visual acuity improved from 20/80 to 20/40 postoperatively, mean IOP was reduced from 21.0 mmHg preoperatively to 16.3 mmHg postoperatively and mean number of glaucoma medications was reduced from 2.3 preoperatively to 0.7 postoperatively (all p<0.01). Sustained long-term successful glaucoma control was achieved in 93.5% of cases. Mean time to glaucoma surgical failure in the 6.5% of failed eyes was 48.8 months and failure time ranged from 1.4 to 225 months postoperatively. Mitomycin C use was reduced from 72.2% of cases between 1987 and 2007 to 20.6% of cases from 2008-2017. The number of eyes with a late bleb leak was reduced from 10 (0.78%) cases (1987-2007) to no (0%) of cases after 2007. Late bleb-related endophthalmitis was reduced from 13 (1.0%) cases (1987-2007) to one (0.17%) of cases (2008-2017).
Conclusions :
Combined cataract and trabeculectomy surgery can successfully improve visual acuity, reduce IOP and reduce the need for postoperative glaucoma medication. Glaucoma surgical success rate is high (93.5%) and failures occur early or late after surgery. Reducing the use of intraoperative mitomycin C can significantly reduce the risk of late bleb leaks and late postoperative endophthalmitis.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.