The long-term effect of phacoemulsification combined with trabeculectomy and intraoperative 5-fluorouracil in glaucoma patients

Abstract

This study was designed to evaluate the long-term effect of phacoemulsification, lens implantation combined with trabeculectomy augmented with 5-Fluorouracil (phaco-trab-5-Fu) in Asian glaucoma patients with primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG). This retrospective study included 71 consecutive patients who underwent phaco-trab-5-Fu in Singapore National Eye Center between January 1996 and December 1998. Patients with follow-up time less than 6 months were excluded from the study. The mean follow-up time was (53.1 +/- 20.9) months. Postoperative IOP was significantly lower than preoperation [(15.0 +/- 4.0) mmHg (1 mmHg = 0.133 kPa), (20.3 +/- 5.4) mmHg, respectively, P < 0.01]. Postoperative number of antiglaucoma medications was also significantly decreased than preoperation (P < 0.01). IOP of 1 to 5 years postoperation dropped significantly from that of preoperation (P < 0.01). Complete success (CS) rate of phaco-trab-5-Fu was 84.2%, 62.7%, 55.3% for 1, 3, 5 years, respectively. There were neither significant difference found in PACG group and POAG group, or in single-incision and separate-incision of CS rate. But mean IOP of last follow-up was significantly different between PACG and POAG [mean IOP (13.8 +/- 4.6) mmHg, (16.2 +/- 3.7) mmHg, respectively, P = 0.02]. According to LogMAR chart, mean preoperative visual acuity (VA) and postoperative VA were 0.75 +/- 0.40 and 0.46 +/- 0.46, respectively. Postoperative VA was significantly improved (P < 0.01). In visual field, MD were (-16.6 +/- 8.8) dB and (-17.6 +/- 10.1) dB at preoperation and postoperation, respectively. PSD were (6.2 +/- 2.9) dB and (6.5 +/- 3.2) dB correspondingly. There were no significant difference in both MD and PSD (P = 0.55, 0.64, respectively). One patient had early endophthalmitis and required vitrectomy. Two late-onset of hypotony were due to choroidal effusion and wound leak. Phacoemulsification combined with trabeculectomy and 5-Fu could be a successful and safe treatment for patients with cataract and primary glaucoma in a long run. There is no difference in success rate in PACG and POAG, or in single incision or separate incision in such combined surgery.