Comparison of phacotrabeculectomy and sequential surgery in the treatment of chronic angle-closure glaucoma coexisted with cataract

Five-Year Outcomes of Trabeculectomy and Phacotrabeculectomy

Purpose The purpose of this study is to examine five-year outcomes of trabeculectomy and compare the stand-alone procedure when combined with phacoemulsification. Patients and methods This study included 123 eyes of 109 patients, with 79 patients in the trabeculectomy group and 44 patients in the phacotrabeculectomy group. Non-randomized comparative cohort study with data collected retrospectively from an existing database compiled by a single surgeon operating in Sydney, Australia from 2007 to 2019. The primary outcome measure was intraocular pressure. Secondary outcome measures were a number of glaucoma medications, treatment success rates, best-corrected visual acuity, bleb morphology, post-operative complications, and re-operation rate. Results The mean intraocular pressure was 10.6 ± 2.7 mm Hg in the trabeculectomy group (pre-operative mean intraocular pressure of 28.0 ± 9.8) and 12.0 ± 3.0 mm Hg in the phacotrabeculectomy group (pre-operative mean intraocular pressure of 23.4 ± 7.9) after five years (P = 0.052). The number of glaucoma medications required was 0.3 ± 0.7 in the trabeculectomy group (pre-operative mean of 3.7 ± 1.1) and 1.3 ± 1.2 in the phacotrabeculectomy group (pre-operative mean of 3.1 ± 1.0, P < 0.001). Conclusions Intraocular pressure reduction post-operatively over five years was similar between trabeculectomy and phacotrabeculectomy as determined by mean intraocular pressure, and intraocular pressure reduction from baseline. However, fewer supplemental glaucoma medications were required following trabeculectomy as compared to the combined procedure.

Modified phacoemulsification plus goniosynechialysis compared with conventional surgery for cataract and glaucoma

Optic nerve damage and visual impairment caused by glaucoma affect 66.8 million people worldwide, and causing bilateral blindness in 6.7 million people. Surgery is the main method for the treatment of cataract with glaucoma. In recent years, clinicians have increasingly paid attention to and applied phacoemulsification and intraocular lens implantation combined with goniosynechialysis for the treatment of cataract with angle-closure glaucoma. However, for patients with complicated cataract, the high ultrasonic energy of traditional phacoemulsification can largely damage the corneal endothelium. Modified phacoemulsification (lower ultrasonic energy) and intraocular lens implantation have now achieved certain efficacy. The efficacy and safety of modified phacoemulsification plus goniosynechialysis compared with conventional surgery for cataract and glaucoma was investigated. A total of 125 patients who underwent goniosynechialysis combined with phacoemulsification and intraocular lens implantation were enrolled in the control group, while 179 patients treated by modified phacoemulsification and intraocular lens implantation combined with goniosynechialysis were enrolled in the research group. The visual acuity and intraocular pressure were observed before and 6 months after surgery in both groups, and the incidence of complications was analyzed. After treatment, there were more patients with visual acuity of 0.2-0.4 and >0.4 in the research group than in the control group (P<0.05). The incidence of corneal edema and anterior chamber inflammation was lower in the research group than in the control group (both P<0.05), while the preoperative and postoperative intraocular pressure, central anterior chamber depth, angle-opening distance, and peripheral iridocorneal adhesions were not significantly different between the two groups (all P>0.05). Modified phacoemulsification and intraocular lens implantation plus goniosynechialysis for cataract with glaucoma can better improve the visual acuity, as well as effectively reduce corneal edema and anterior chamber inflammation.