Temporal corneal phacoemulsification combined with superior trabeculectomy. A retrospective case-control study
H. J. Park, M. Weitzman and J. Caprioli
Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Conn, USA.
OBJECTIVE: To determine the results of temporal corneal phacoemulsification
combined with separate-incision superior trabeculectomy plus low-dose
5-fluorouracil compared with trabeculectomy plus low-dose 5-fluorouracil.
DESIGN: Retrospective case-control study. PATIENTS: Forty consecutive case
patients who underwent temporal corneal phacoemulsification combined with
superior trabeculectomy plus low-dose 5-fluorouracil (case [combined
surgery] group) and 40 control patients, matched for age race, preoperative
intraocular pressure (IOP), number of preoperative antiglaucoma
medications, and number of 5-fluorouracil injections, who underwent
trabeculectomy alone plus low-dose 5-fluorouracil (control [trabeculectomy]
group). MAIN OUTCOME MEASURES: Survival analyses for IOP control compared
between the 2 groups. METHODS: The medical records of 40 consecutive case
patients were reviewed to determine the effect of their treatment on IOP,
visual acuity, and requirement for glaucoma medications. In the control
group, 40 eyes (1 eye per patient) were randomly selected for comparison
with the case group. In both groups, the trabeculectomy was located
superiorly and performed with the same technique and using a limbus-based
conjunctival flap. In the case group, temporal corneal phacoemulsification
immediately preceded trabeculectomy and used a 3.2-mm incision and a
1-piece silicone intraocular lens. All patients received 3 or 4
subconjunctival 5-fluorouracil injections of 5 mg each within the first 11
postoperative days. Patients were followed up for at least 1 year. Success
of surgery was defined as an IOP of less than 22 mm Hg and a 20% or more
reduction from the preoperative level on 2 consecutive follow-up visits,
regardless of the use of antiglaucoma medications. RESULTS: The mean
(+/-SD) postoperative IOP was statistically higher in the case group than
in the control group at each follow-up interval (P < .05). The mean
(+/-SD) IOP reductions at 1 year were 6.8 +/- 5.5 mm Hg and 10.3 +/- 7.6 mm
Hg (39.2% +/- 18.8%) in the case and control groups, respectively (P =
.04). The reductions in the mean (+/-SD) number of antiglaucoma medications
at 1 year were 1.6 +/- 0.9 and 2.0 +/- 1.0 in the case and control groups,
respectively (P = .06). In the case group, the mean visual acuity beyond
the first postoperative month was significantly better than at baseline (P
< .001). Kaplan-Meier survival analysis showed that the cumulative
success rates at 2 years were 62.1% and 85.8% in the case and control
groups, respectively. The survival time to failure was significantly
shorter (P = .04) in the case group by the log-rank test. CONCLUSIONS:
Combined surgery for cataract and glaucoma is associated with less
long-term IOP reduction compared with trabeculectomy alone despite
identical trabeculectomy techniques used in both groups. Nevertheless,
combined surgery lowers IOP and reduces the long-term requirement for
antiglaucoma medications. This technique is appropriate in selected
patients with coexisting cataract and glaucoma.
