Clinical efficacies of scleral tunnel sutureless trabeculectomy plus phacoemulsification and intraocular lens implantation

Abstract

To explore the clinical efficacies of scleral tunnel sutureless trabeculectomy plus phacoemulsification and intraocular lens implantation in the treatment of glaucoma and cataract. A total of 49 cataract patients with glaucoma (52 eyes) from our hospital during the period of February 2009 to June 2012. Their visual acuities were < 0.3 and intraocular pressure was not desirable or in need of various ocular hypotensive drugs. A phaco tunnel knife was employed to prepare a 4 mm × 4 mm scleral tunnel flap with 1/2-2/3 whole layer of sclera depth. Phacoemulsification instrument was used to emulsify cataracts. Foldable intraocular lens was implanted. A trabecular cut of 2 mm × 1.5 mm was made under the scleral tunnel. Tile scleral flap was not sutured and conjunctival flap tightly closed. After a 12-month follow-up, > 0.5 in 42 eyes (80.8%). The intraocular pressure was 11.32 - 17.63 mm Hg (1 mm Hg = 0.133 kPa) and the mean intraocular pressure (13.59 ± 4.26) mm Hg. There was a mean pressure reduction of 11.2 mm Hg from (24.53 ± 5.71) mm Hg pre-operation. Statistical significance existed (t' = 11.073, P < 0.01). The filtering blebs of type I-II was 43 eyes (82.6%) and the mean central anterior chamber 3.28 mm ± 0.42 mm. There was statistical difference (t' = 20.486, P < 0.01) with (1.79 ± 0.31) mm at pre-operation. On 52 eyes, the mean postoperative astigmatism was (1.01 ± 0.62) D versus (1.13 ± 0.74) D at pre-operation. There was no statistical significance (F = 2.0673, P > 0.05). No severe complication occurred in all cases. Compared with traditional trabeculectomy and triple procedure, this improved and updated procedure lowers intraocular pressure, improves visual acuity and decreases the occurrences of complications. It is a safe, reasonable, quick and effective treatment for cataract patients with glaucoma.