Jessica Lai, David Wechsler
To compare the results of trabeculectomy with two-site phaco-trabeculectomy in patients requir-ing surgical management of glaucoma.
Retrospective analysis of patients in a pro-spective database who underwent trabeculectomy or phaco-trabeculectomy for POAG, PXF-related or angle closure glaucoma between June 2008 and June 2011. Apart from the concomitant phacoemulsification cata-ract extraction via a separate corneal incision, all patients underwent an identical fornix-based trab-eculectomy. Patients were excluded if they did not have a minimum of 1-year follow-up and, if glaucoma was secondary to uveitis or anterior segment neovascularisation.
41-trabeculectomy patients and 24-phaco-trabeculectomy patients had a mean pre-operative IOP of 29.5 mmHg and 23.2 mmHg, respectively. This was reduced to 13.3 mmHg and 13.0 mmHg at 6-months, and 12.8 mmHg and 13.0 mmHg at 12-months.Absolute success rates at 6-months were 76.3% and 68.1% respectively for IOP < 18 mmHg, 68.4% and 63.6% for IOP < 16 mmHg, and 36.8% and 40.9% achieving IOP < a predetermined target IOP. At 12-months, the trabeculectomy group had 70.5% with IOP < 18 mmHg; 67.6% with IOP < 16 mmHg; and 44.1% with IOP < target IOP, and phaco-trabeculec-tomy had 55%, 50% and 30% respectively.Qualified success rates for trabeculectomy at 6-months were 86.8% with IOP < 18 mmHg, 76.3% with IOP < 16 mmHg; and 42.1% with IOP < target IOP, and for phaco-trabeculectomy at 6-months were 90.9%, 81.8%, and 54.5% respectively. At 12-months quali-fied success for trabeculectomy was 94.1%, 88.2% and 55.8% respectively, and 85%, 80% and 45% for phaco-trabeculectomy. Conclusion: Phaco-trabeculectomy is a useful tech-nique in managing patients with concomitant cataract and glaucoma requiring surgical intervention, as similar IOP outcomes can be achieved when compared to stand-alone trabeculectomy.