Combined phacoemulsification–viscosynechialysis–trabeculotomy vs phacotrabeculectomy in uncontrolled primary angle-closure glaucoma with cataract

Abstract

To compare the effect on intraocular pressure (IOP) of phacoemulsification combined with viscosynechialysis and trabeculotomy with that of phacoemulsification combined with trabeculectomy in eyes with primary angle-closure glaucoma (PACG) and visually significant cataract. Mansoura Ophthalmic Center, Mansoura University, Egypt. Prospective case series. This prospective randomized study included patients with uncontrolled PACG and visually significant cataract presenting between 2012 and 2017. The eyes were randomized to phacoemulsification combined with viscosynechialysis and trabeculotomy (phaco-viscosynechialysis group) or phacoemulsification combined with trabeculectomy (phacotrabeculectomy group). Success (true and qualified) (IOP <18mm Hg without sight-threatening complications) was studied 24months postoperatively. Intraoperative complications were noted. The primary outcome measure was the IOP before and after surgery. The study comprised 59 eyes of 59 patients with a mean age of 59.8years±6.8 (SD) in the phaco-viscosynechialysis group (30 eyes) and 60.3±6.3years in the phacotrabeculectomy group (29 eyes) (P=.704). The mean preoperative IOP was 28.7±2.14mm Hg in the phaco-viscosynechialysis group and 28.5±2.11mm Hg in the phacotrabeculectomy group; the mean at 24months was 14.5±2.8mm Hg and 17.3±2.2mm Hg, respectively (P<.001). The total success rate at 24months was 90% and 83%, respectively. Although both techniques were relatively safe and effective in reducing IOP for at least 2years in eyes with PACG, combined phacoemulsification-viscosynechialysis-trabeculotomy gave better outcomes.