Five-Year Outcomes of Trabeculectomy and Phacotrabeculectomy

Abstract

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.

CO2 Laser-Assisted Sclerectomy Surgery Alone or Combined with Phacoemulsification in Primary Open-Angle Glaucoma: Comparison of 1-Year Outcomes

“…In our study, functional bleb was more common in CLASS group than in combination group (60.9% vs 8.7%), which contributed to a greater IOP-lowing effect. In a 5-year comparison study, there were more eyes with a significantly higher and more extensive bleb in the trabeculectomy group than in the phacotrabeculectomy group [30]. So far, to our knowledge, this is the first study evaluating the filtering bleb and exploring the mechanisms of IOP reduction between CLASS alone and combined with Phaco, which deserves further attention.…”

Comparison of Ex-PRESS implantation versus trabeculectomy combined with phacoemulsification in primary open-angle glaucoma: a retrospective in vivo confocal microscopy study

“…The development of cataract surgery technique has made combined surgery an attractive option for the patients with coincident POAG and cataract [ 1 ]. However, trabeculectomy alone can produce 50% of the complete success rate at 5 years postoperatively, but it was reduced to 19% in combined surgery Phaco-Trab [ 25 ]. It was possible that the combination surgery intensified postoperative inflammation to accelerate the fibrosis of filtering bleb leading to unsatisfied IOP control [ 8 , 9 ].…”

Trabeculectomy: Does It Have a Future?

“…Another study by Tan et al gave contrasting results with a higher rate of complications in the TRAB group than in the PT group [55]. Lam and Wechsler found comparable IOP reduction in both eyes at 5 years with both procedures, though, the number of AGMs required postoperatively was higher in the PT group [56].…”

“…Since cataract extraction alone was reported to cause IOP reduction, TRAB has been compared with cataract extraction alone in POAG and primary angle-closure glaucoma (PACG) [46][47][48][49][50][51][52][53][54][55][56][57]. Tham et al [46] compared phacoemulsification (PHACO) alone to TRAB with MMC in medically uncontrolled angle-closure glaucoma without cataracts.…”

“…There had been numerous studies comparing TRAB with phaco trabeculectomy with anecdotal results (Table 1) [50][51][52][53][54][55][56][57]. However, a recent metanalysis on phaco trabeculectomy (PT) versus TRAB (TRAB) with or without later phacoemulsification did not find a significant difference in IOP reduction between the two procedures.…”