Comparison of Early Postoperative Complications in Trabeculectomies Alone Versus Trabeculectomies with Cataract Extraction

Abstract

OBJECTIVE: To compare the rate of early postoperative complications in trabeculectomies alone vs. combined procedures. STUDY DESIGN: Retrospective analysis of files of patients who underwent trabeculectomies or combined procedures between 1 January 1988 and 31 December 1990. SETTING: St John Eye Hospital, Johannesburg. PATIENTS: One hundred and twenty-one patients underwent trabeculectomy alone and 55 had combined procedures. All patients were older than 58 years. MAIN OUTCOME MEASURES: Postoperative complications, cataract formation, change in visual acuity and IOP control. RESULTS: The incidence of anterior chamber loss in trabeculectomies was 20.7% vs . 5.4% in combined procedures. Choroidal detachments (4%), hyphemas (10%), and transient elevation of IOP (11%) occurred almost equally in both groups. Cataract formation was accelerated particularly in trabeculectomy patients who suffered from transient loss of anterior chamber. Consequently, the visual acuity dropped markedly in 20.7% of the trabeculectomy patients postoperatively, whereas 90.9% of patients in the combined procedure group improved their visual acuity. The IOP control was similar in both groups. CONCLUSIONS: The cataractogenic effect of trabeculectomies in elderly patients is amplified when transient loss of anterior chamber occurs. These data suggest that a combined procedure may be not only safer, but also more rewarding than trabeculectomy alone in an elderly patient requiring filtering surgery.