Insufficiency fractures occur within weakened bones that are unable to withstand the stress of every day normal activities. The spine, pelvis, and lower long-bone extremities are common sites of insufficiency fractures. Spontaneous sternal insufficiency fracture (SIF) has rarely been reported in elderly patients. To recognise a sternal insufficiency fracture is important in selecting the adequate diagnostic procedures.

Background: To investigate long-term refractive outcomes after phacotrabeculectomy and to determine risk factors that may cause unstable refractive outcomes after phacotrabeculectomy in glaucoma patients.Methods: A total 120 eyes of 120 patients who had underwent uncomplicated phacotrabeculectomy (combined group) or phacoemulsification (phaco-only group) were included. Best-corrected visual acuity (BCVA), intraocular pressure (IOP) were measured before and after surgery, and anterior segment parameters including anterior chamber depth (ACD), lens vault (LV), and anterior vault (AV) measured using anterior-segment optical coherence tomography were compared between the two groups. The mean absolute error (MAE) at 3, 6, 12, and 24 months postoperatively were compared. Risk factors associated with unstable refractive outcomes (MAE ≥ 0.5) were investigated in the combined group.Results: In both groups, BCVA was improved and IOP was decreased significantly. MAE at 3, 6, 12, 24 months postoperatively were not significantly different between two groups. The risk factors for unstable refractive outcomes after 12 months of phacotrabeculectomy were old age and LV. Whereas, the only factor predicting unstable refractive outcome after 24 months of phacotrabeculectomy was LV. The cut-off value of LV for predicting unstable refractive outcome analyzed by the ROC curve was 0.855 mm.Conclusions: Phacotrabeculectomy may be an effective treatment with predictable long-term refractive outcomes similar to phacoemulsification in patients with glaucoma. However, elderly patients or patients with large LV may be predisposed to unpredictable postoperative refractive outcomes after phacotrabeculectomy.