[Combination of phacoemulsification and trabeculectomy. Results of a retrospective study]

Phaco-trabeculotomy combined with deep sclerectomy, a new technique in combined cataract and glaucoma surgery: complication profile

PURPOSE

Combined phacoemulsification, intraocular lens implantation and trabeculectomy (PTE) is currently the standard procedure for most ophthalmic surgeons for treating uncontrolled open-angle glaucoma and cataract at the same time. The present pilot study was designed to prospectively evaluate outcomes in glaucoma patients who underwent a new technique of phaco-trabeculotomy plus deep sclerectomy, with particular attention to the complication profile.

METHODS

A consecutive series of 15 patients with uncontrolled open-angle glaucoma and cataract underwent combined glaucoma and cataract surgery. The procedure started as a two-site approach with phacoemulsification and intraocular lens (IOL) implantation through a temporal incision in clear cornea. Trabeculotomy and deep sclerectomy were performed in the superior quadrant. Postoperative examinations were performed daily for 1 week. Follow-up visits were carried out at 1, 3, 6 and 12 months after surgery.

RESULTS

At 1 day post-surgery, mean intraocular pressure (IOP) was significantly reduced to 14.2 mmHg (SD 4.4). At 12 months post-surgery, the complete success rate, defined as IOP < 22 mmHg without medication, was 60%. Qualified success was achieved in 93.3% of patients. At 12 months post-surgery, the mean number of antiglaucoma medications had fallen to 0.4 (SD 0.6) (p < 0.001). Visual acuity improved by a mean value of 1.6 lines (SD 2.4) over baseline (p = 0.021). Specific complications such as choroidal deroofing, inadvertent perforation of the trabeculo-descemetic membrane, and non-identification of Schlemm's canal were seen among the patients in our trial. The incidence of complications due to overfiltration was low. A relatively high incidence of hyphaemas (53%) was noted in this series. All the hyphaemas were trivial and resolved quickly. No severe complications, such as bleb infection, endophthalmitis or choroidal haemorrhage were seen in this series.

CONCLUSIONS

Phaco-trabeculotomy plus deep sclerectomy offered significant IOP reduction and a success rate that may be comparable with that of the current standard, PTE. Intra- and postoperative complications specific to deep sclerectomy and trabeculotomy were seen in our series, although the overall rate of postoperative complications proved low. Prospective comparative trials are needed to assess which of PTE and phaco-trabeculotomy plus deep sclerectomy is more successful.

Combined surgery for cataract and glaucoma: phacoemulsification and deep sclerectomy compared with phacoemulsification and trabeculectomy

PURPOSE

To compare the outcome of phacoemulsification-intraocular lens (IOL) implantation combined with nonperforating deep sclerectomy (P-DS) with that of phacoemulsification-IOL implantation combined with trabeculectomy (P-T).

SETTING

Glaucoma Unit, Department of Ophthalmology, University of Lausanne, Switzerland.

METHODS

This prospective study involved 60 eyes of 60 patients with cataract and various types of open-angle glaucoma. Thirty eyes had P-DS and 30, P-T. Follow-up was performed at regular intervals for up to 18 months.

RESULTS

Mean follow-up was 12.5 months +/- 6.5 (SD) and 12.6 +/- 4.9 months for the P-DS and P-T groups, respectively. Mean preoperative intraocular pressure (IOP) was similar in both groups (24.8 +/- 5.9 mm Hg in the P-DS group and 24.6 +/- 7.2 mm Hg in the P-T group). There was no statistically significant difference in IOP decrease (14.2 +/- 4.0 mm Hg in the P-DS group and 15.2 +/- 2.8 mm Hg in the P-T group). Visual outcome was similar in both groups. The P-DS group experienced significantly less inflammation (40.0% versus 83.0%; P = .0012) and hyphema (6.7% versus 36.7%; P = .010) than the P-T group.

CONCLUSION

Deep sclerectomy combined with cataract surgery resulted in an IOP reduction similar to that with phacotrabeculectomy with the same visual outcome, but the lower complication rate makes ambulatory care easier.