Combined Phacoemulsification, Posterior Chamber Intraocular Lens Implantation, and Trabeculectomy With Mitomycin C

Abstract

We evaluated the effectiveness of combined phacoemulsification, posterior chamber intraocular lens implantation, and trabeculectomy with mitomycin C in patients with coexisting cataract and glaucoma. We conducted a retrospective review of the records of 21 consecutive patients who had combined phacoemulsification, posterior chamber intraocular lens implantation, and trabeculectomy with mitomycin C. Patients were selected for the combined procedure on the basis of the degree to which intraocular pressure was controlled, toleration of medical therapy, degree of glaucomatous optic nerve damage, and extent of visual impairment because of cataract. Nine (43%) of the 21 patients had previous incisional surgery and were at high risk of surgical failure. All patients had at least six months' follow-up. Sixteen (76%) of 21 patients had at least one year of follow-up. The mean preoperative intraocular pressure was 20.8 +/- 5.0 mm Hg (range, 13 to 35 mm Hg), which decreased to a mean postoperative intraocular pressure of 15.1 +/- 3.1 mm Hg (range, 9 to 21 mm Hg) as measured at last follow-up (P = .0002). The intraocular pressure was controlled between 6 and 21 mm Hg) in all patients at last follow-up. Seventeen (81%) of 21 patients had a best-corrected visual acuity of 20/40 or better at last follow-up. No patient had a decrease in visual acuity after surgery. Fifteen (71%) of 21 patients were using no antiglaucoma medications at last follow-up. Four of the remaining six patients were using one medication, and two were using two medications. A hyphema (less than 1.0 mm) was seen in seven (33%) of 21 patients and was the most common postoperative complication. No patient had a postoperative wound or bleb leak or a shallow anterior chamber. No patient developed symptomatic hypotony. The glaucoma triple procedure with adjunctive mitomycin C appears to be a safe and effective surgical technique for treating selected patients with coexisting cataract and glaucoma.