Comparison of outcomes between phacoemulsification-trabeculectomy and ECCE-trabeculectomy for cataract combined with glaucoma

Abstract

Background Phacoemulsification (Phaco) and extracapsular cataract extraction (ECCE) with trabeculectomy are primary approachs for cataract combined with glaucoma. To compare the efficiency and safety between the two methods is important for the choice of surgeries. Objective This study was to compare the clinical outcomes between ECCE combined with trabeculectomy and Phaco combined with trabeculectomy. Methods A randomized controlled study was designed. Sixty-three eyes of 63 patients with cataract and glaucoma were included from January 2013 to February 2014 in Xinjiang Autonomous District Traditional Chinese Medicine Hospital under the informed consent. The patients were assigned to parallel two groups according to random number table. ECCE+ intraocular lens (IOL) implantation with trabeculectomy was performed in 33 eyes of 33 patients in the ECCE-teabelectomy group, and Phaco+ IOL implantation with trabeculetomy was carried out in 30 eyes of 30 patients in the Phaco-trabeculectomy group. The patients were followed-up for six months. Visual acuity, intraocular pressure (IOP), astigmatic degree and complication after surgery were compared between the two groups. Results The visual acuity was obviously improved after surgery in both groups. The distribution of eyes in different vision acuities was significantly different after operation between the two groups (H=0. 125, P=0. 032). The IOP was (14. 13±5. 19)mmHg in the Phaco-trabeculectomy group and (15. 18±6. 04) mmHg in the ECCE-trabeculectomy group, without significantly interclass difference among the two groups (F=3. 762, P>0. 05), however, the IOP were lower after surgery (Ftime=14. 991, P<0. 05). The postoperative astigmatic power was (1. 02±0. 44) D in the Phaco-trabeculectomy group and (3. 76±1. 53) D in the ECCE-trabeculectomy group, showing a significant reduce in the Phaco-trabeculectomy group (t=3. 089, P=0. 034). The incidence rates of postoperative complications were 6. 67% and 18. 18% in the Phaco-trabeculectomy group and ECCE-trabeculectomy group, respectively, with a significant difference between them (χ2=6. 112, P<0. 05). Conclusions Compared to the ECCE+ IOL implantation with trabeculectomy, Phaco+ IOL implantation with trabeculectomy for cataract combined with glaucoma shows better clinical effectiveness, less complications and lower astigmatic power. Key words: Cataract/surgery; Glaucoma/surgery; Phacoemulsification; Extracapsular cataract extraction; Trabeculectomy; Combined surgery; Comparative study