Abstract
Purpose :
We compared the surgical probabilities of trabeculectomy followed by phacoemulsification versus trabeculectomy alone for 5 years in the Collaborative Bleb-Related Infection Incidence and Treatment Study (CBIITS), Japan.
Methods :
From the 1,098 glaucoma eyes in 34 clinical centers in CBIITS, primary open angle glaucoma (POAG) or exfoliation glaucoma eyes that underwent trabeculectomy with mitomycin C were analyzed. During follow-up visit after trabeculectomy, some eyes were treated with phacoemulsification because of cataract progression. We divided the participants into the trabeculectomy followed by phacoemulsification group and the trabeculectomy alone group. Surgical failure (intraocular pressure: IOP ≥ 21, 18, or 15 mm Hg for criteria A, B or C, respectively; <20% decrease from baseline; reoperation for glaucoma; loss of light perception vision; or low IOP ≤ 5 mmHg) was compared between the 2 groups.
Results :
There were 40 and 208 eyes treated with the trabeculectomy followed by phacoemulsification group and the trabeculectomy alone group, respectively. Preoperative IOP (mean ± SD) was 22.1 ± 8.7 and 20.5 ± 6.3 mm Hg (P = 0.47). The cumulative probabilities of success during 5 years were 40.0 % and 59.1 % for criteria A (P = 0.01), 35.0 % and 52.9 % for B (P = 0.01), and 25.0 % and 37.5 % for C (P = 0.08) in the trabeculectomy followed by phacoemulsification group and the trabeculectomy alone group, respectively. Shorter period between trabeculectomy and phacoemulsification was significantly associated with surgical failure in Cox-proportional multivariable analysis for criteria A [relative risk (RR) = 0.98; P = 0.01], B [RR = 0.98; P < 0.01] and C [RR = 0.99; P = 0.04].
Conclusions :
Phacoemulsification adversely affects the surgical outcomes in eyes that had undergone trabeculectomy. Especially, the shorter period between trabeculectomy and phacoemulsification results in lower probabilities of success.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.