Abstract
AbstractPurpose cataract surgery alone may have a beneficial effect in glaucoma patients by mildly lowering the intraocular pressure but loss of intraocular pressure (IOP) control may occur after cataract operation. It has also been suggested that patients presenting with more advanced glaucoma may have better outcomes with surgery than medical treatment. The purpose of the study is to investigate the postoperative results of two surgical alternatives: phaco only versus combined phaco trab operation in eyes with advanced glaucoma and controlled IOP.Methods Prospective study of 78 patients with advanced open angle glaucoma (MD≥12 dB) with IOP≤21mmHg on topical medication and visually significant cataract (VA ranging from Hand Movements to 4/10). All patients were randomized to have either combined surgery (phaco‐trab, two‐sites, using adjustable sutures) (Group A, 39 eyes) or phaco only ( clear cornea temporal approach) (Group B, 39 eyes). Follow up for 6 months. VA, IOP and VF were measured regularly with appropriate IOP control. Postoperative complications were recorded.Results Phaco group showed faster visual recovery, higher peak IOP, greater IOP fluctuations and less MD difference than phaco_trab group, with the latter performing worse. Final VA didn't differ significantly between groups. Major complications: 9 choroidal detachments and 1 hyphema in Group A.Conclusion for the first 6mo postoperatibvely higher IOPs in phaco only patients do not seem to worsen glaucoma lesions given strict IOP control. Even more, phaco_only eyes show faster visual improvement and need less prolonged intensive postoperative monitoring than phaco_trab eyes.
Published Version
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