The safety and efficacy of combined phacoemulsification and trabeculectomy with releasable sutures

Abstract

Aim: To evaluate the combined phacoemulsification with acrylic intraocular lens implantation and trabeculectomy with releasable sutures, without the use of antimetabolites, performed by one surgeon. Methods: A retrospective analysis was performed on 251 eyes of 198 patients after a combined phaco/trabeculectomy procedure, followed up for an average of 16 months for vision, intraocular pressure (IOP), and number of glaucoma medications. Cox proportional hazard regression analysis provided measures of relative risk (RR) or hazards ratios and 95% confidence intervals (CIs) associated with the occurrence of several conditions or complications of surgery. Results: Mean preoperative variables were best corrected vision, 0.6 (SD 0.4) logMAR (20/80 Snellen); IOP, 18.7 (4.9) mm Hg; and number of glaucoma medications, 1.7 (0.8). Mean postoperative results were best corrected vision, 0.2 (0.4) logMAR (20/32 Snellen); IOP, 15.1 (3.2) mm Hg; and number of glaucoma medications, 0.3 (0.6). Postoperatively, the mean decreases from baseline were 19.2% for IOP and 84.1% for number of glaucoma medications; 85% of eyes required fewer glaucoma medications and 78% of eyes were medication free, with IOP control. There were no significant operative or postoperative complications. Conclusion: Combined phacoemulsification and trabeculectomy with releasable sutures, in the absence of antimetabolites, is a safe, effective, and stable alternative for patients with cataracts and glaucoma.

Phacoviscocanalostomy versus cataract surgery only in patients with coexisting normal-tension glaucoma: Midterm outcomes

“…Jongsareejit et al 6 report that only about 40% of Japanese patients with NTG successfully maintained an IOP level 20% lower than the preoperative IOP after trabeculectomy with MMC. Stark et al 41 report that they performed phacotrabeculectomy without antimetabolite agents in white glaucoma patients with low IOP (mean 18.7 mm Hg); the final mean reduction was 19.2%. These results are comparable to ours.…”

Surgical outcome of safe surgery system trabeculectomy combined with cataract extraction

“…3,6 Stark et al 19 found mean IOP reduction of 19.2% in a retrospective analysis of phacotrabeculectomy without antimetabolites. It is likely that greater percentage reduction in IOP were achieved owing to higher preoperative IOP levels, which must be kept in mind while comparing different studies.…”

“…7 The overall success achieved (IOPr18 mm Hg) without or with medication was 490% when combined with either MSICS (90.6%) or phacoemulsification (95.4%), which was better than combined surgery results on Indian eyes. 3,19 We also analyzed the success taking IOPr15 and r12 mm Hg in both types of surgeries. The success reported was 70 and 51% with MSICS and 73 and 50% with phacoemulsification, respectively.…”

The Safety and Efficacy of Two-site Phacotrabeculectomy with Mitomycin C under Retrobulbar and Topical Anesthesia

“… 13 20 Without MMC, Stark et al achieved a 78% medication-free rate over a period of 42 months in a primarily white population. 9 We achieved a medication-free rate of 61% at the final consultation, and the average patient decreased 1.0 ± 1.3 medications. Our patients were predominantly of West Indian race and we found that with MMC application many patients were able to achieve target pressures without medication.…”

“… 7 However, several authors have recently achieved comparable success rates with single surgical sites and without MMC. 9 - 11 Patients with risks for filtration failure, such as black race, diabetes mellitus, and use of more than two preoperative glaucoma medications, are often recommended simultaneous MMC to prevent failure and glaucoma progression. 12 However, its use is associated with increased bleb leaks and the long-term risk of blepharitis, endophthalmitis, and hypotony.…”