Combined Phacoemulsification with Posterior Chamber Intraocular Lens Implantation and Mitomycin-Augmented Trabeculectomy in Glaucoma Patients

Abstract

Purpose: Cataract and glaucoma commonly coexist in elderly patients and present complex treatment options. This study evaluates the long-term intraocular pressure (IOP) reduction effect and the benefit of adjunctive subconjunctival mitomycin C (0.04% MMC) in combining phacoemulsification with posterior chamber intraocular lens implantation and trabeculectomy (combined surgery). Methods: A retrospective analysis was performed in 52 consecutive patients who had undergone combined surgery. All had limbus-base conjunctival flaps resutured at the fornix. All patients had follow-up at least 12 months. Results: The mean pre-operative IOP was 25.7 (range, 21-48) mmHg and the mean post-operative IOP was reduced significantly to 12.2 (range, 6-24) mmHg (p＜0.001); 44 (84.6%) patients had IOPs controlled at 15 mmHg or less. The mean number of medications decreased from 2.1 to 0.1 at 1-year follow up; 47 (90.4%) patients required no medication. The filtering blebs from the limbal-based conjunctival flaps were predominantly large, diffuse, and noncystic. The best-corrected visual acuity was 6/12 or better in 36 (69.2%) of patients. Conclusion: Control of IOP and improvement of visual acuity can be achieved in a high percentage of patients with coexisting cataract and glaucoma by performing combined surgery using intraoperative mitomycin and limbal based conjunctival flaps. The filtering blebs illustrated a distinctive morphology. No visible adverse effect on corneal endothelium or limbal wound healing was detected with intraoperative application of 0.04% MMC.