Abstract
BackgroundWe aimed to compare the outcomes of trabeculectomy combined with phacoemulsification and those of trabeculectomy followed by phacoemulsification.MethodsA total of 141 patients with primary open-angle glaucoma, exfoliation glaucoma, and glaucoma secondary to uveitis glaucoma who underwent trabeculectomy followed by (n = 48) or combined with (n = 93) phacoemulsification were included. We analyzed data collected from the Collaborative Bleb-Related Infection Incidence and Treatment Study, a prospective cohort study conducted in 34 clinical centers that included 1249 eyes. The main outcome was the cumulative probability of success based on intraocular pressure (IOP) within 5 years. Surgical failure was defined as a case in which additional glaucoma surgery is required or one of the following criteria are met: preoperative IOP > 21 (A), > 18 (B), or > 15 mmHg (C). The secondary outcomes were cumulative probability of success, risk factors of surgical failure, and Δ visual acuity. However, the data on phacoemulsification during the 5-year follow-up were censored.ResultsNo significant difference was found in the cumulative probability of success as the main outcome. When the data on phacoemulsification during the 5-year follow-up were censored, the probabilities of success of trabeculectomy followed by phacoemulsification were significantly higher for criteria A (p = 0.02), B (p < 0.01), and C (p < 0.01). Lower preoperative IOP, younger age, and trabeculectomy combined with phacoemulsification were associated with poorer outcome. Trabeculectomy followed by phacoemulsification had significantly worse Δ logMAR visual acuity at 6 and 12 months (p < 0.01).ConclusionThe cumulative probability of success after trabeculectomy combined with or followed by phacoemulsification remained unchanged. Combining phacoemulsification with trabeculectomy adversely affected the cumulative probability of success after trabeculectomy. The visual acuity improvements observed in the early postoperative period after combining phacoemulsification with trabeculectomy disappeared within 5 years.
Highlights
We aimed to compare the outcomes of trabeculectomy combined with phacoemulsification and those of trabeculectomy followed by phacoemulsification
Failure due to insufficient intraocular pressure (IOP) reduction was observed in 18 eyes (38%) based on criterion A, 25 eyes (52%) based on criterion B, and 27 eyas (56%) based on criterion C in the “trabeculectomy followed by phacoemulsification” group, and insufficient IOP reduction was observed in 43 eyes (46%) based on criterion A, 49 eyes (53%) based on criterion B, and 64 eyes (69%) based on criterion C in the trabeculectomy alone group (Table 2)
The results of the present study were consistent with those of previous studies that showed that trabeculectomy combined with phacoemulsification had no significant difference in cumulative probability of success based on IOP as compared with trabeculectomy followed by HR (95% Cl) 0.97 (0.95–0.99)
Summary
We aimed to compare the outcomes of trabeculectomy combined with phacoemulsification and those of trabeculectomy followed by phacoemulsification. When trabeculectomy is performed in patients with glaucoma, the best timing to perform cataract surgery is difficult to determine because the cataract frequently progresses after trabeculectomy [2,3,4] and because phacoemulsification is known to adversely affect IOP control after trabeculectomy [5,6,7]. The numbers of patients with glaucoma and cataract are increasing with the aging of society and population growth worldwide [11]. This situation has caused increasing concern about the best timing to perform cataract surgery for patients with a history of trabeculectomy. No studies conducted in large cohorts and over long periods have assessed surgical outcomes between trabeculectomy followed by phacoemulsification and trabeculectomy combined with trabeculectomy
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