J Korean Ophthalmol Soc.  2011 Nov;52(11):1308-1317.

Treatment Outcome of Phacotrabeculectomy and Trabeculectomy in Patients with Cataracts and Glaucoma

• Choi YJ
• Rhee DJ
• Choi KR

Abstract

PURPOSE
To compare the treatment outcome and complications of phacotrabeculectomy and trabeculectomy in patients with glaucoma and cataracts.
METHODS
The authors of the present study retrospectively reviewed the records of 56 eyes that underwent phacotrabeculectomy and trabeculectomy with mitomycin-C between March 2006 and December 2009 in patients with glaucoma and cataracts. The change of intraocular pressure (IOP) and number of glaucoma medications up to 24 months postoperatively were compared and the treatment failure rate as well as postoperative complications analyzed.
RESULTS
IOP and number of glaucoma medications at 24 months after surgery were similar in the 2 groups. Additionally, both groups showed a significant decrease in IOP and number of glaucoma medications after surgery. The cumulative failure rates, frequency and distribution of postoperative complications were also similar in both groups and conjunctival bleb leak was the most common complication.
CONCLUSIONS
Both phacotrabeculectomy and trabeculectomy showed long-term IOP reduction and a similar failure rate and complications. Therefore, both can be considered as a primary surgical treatment in patients with glaucoma and cataracts. In patients who need strict IOP control, trabeculectomy can be preferentially considered. If patients have visually significant cataracts or greater visual needs, phacotrabeculectomy can be considered.

Keyword

Cataract; Glaucoma; Mitomycin; Phacotrabeculectomy; Trabeculectomy

MeSH Terms

Blister
Cataract
Eye
Glaucoma
Humans
Intraocular Pressure
Mitomycin
Postoperative Complications
Retrospective Studies
Trabeculectomy
Treatment Failure
Treatment Outcome
Mitomycin

Figure

• 

  Figure 1. Kaplan-Meier plots of the cumulative proportional failing in the phacotrabeculectomy and trabeculectomy groups (p = 0.82, log rank test).

Reference

References

1. Shields MB. Another reevaluation of combined cataract and glaucoma surgery. Am J Ophthalmol. 1993; 115:806–11.

2. Lichter PR, Musch DC, Gillespie BW, et al. Interim clinical outcomes in the Collaborative Initial Glaucoma Treatment Study comparing initial treatment randomized to medications or surgery. Ophthalmology. 2001; 108:1943–53.

3. Hylton C, Congdon N, Friedman D, et al. Cataract after glaucoma filtration surgery. Am J Ophthalmol. 2003; 135:231–2.

4. Costa VP, Smith M, Spaeth GL, et al. Loss of visual acuity after trabeculectomy. Ophthalmology. 1993; 100:599–612.

5. Casson RJ, Salmon JF. Combined surgery in the treatment of patients with cataract and primary open-angle glaucoma. J Cataract Refract Surg. 2001; 27:1854–63.

6. Ruderman JM, Fundingsland B, Meyer MA. Combined phacoemulsification and trabeculectomy with mitomycin-C. J Cataract Refract Surg. 1996; 22:1085–90.

7. Pohjalainen T, Vesti E, Uusitalo RJ, Laatikainen L. aberrations and intraocular lens implantation in eyes with open-angle glaucoma. Acta Ophthalmol Scand. 2001; 79:313–6.

8. Vizzeri G, Weinreb RN. Cataract surgery and glaucoma. Curr Opin Ophthalmol. 2010; 21:20–4.

9. Murthy SK, Damji KF, Pan Y, Hodge WG. Trabeculectomy and phacotrabeculectomy, with mitomycin-C, show similar two-year target IOP outcomes. Can J Ophthalmol. 2006; 41:51–9.

10. Joos KM, Bueche MJ, Palmberg PF, et al. One-year follow-up results of combined mitomycin C trabeculectomy and extracapsular cataract extraction. Ophthalmology. 1995; 102:76–83.

11. Kleinmann G, Katz H, Pollack A, et al. Comparison of trabeculectomy with mitomycin C with or without phacoemulsification and lens implantation. Ophthalmic Surg Lasers. 2002; 33:102–8.

12. Peräsalo R, Flink T, Lehtosalo J, et al. Surgical outcome of phacoemulsification combined with trabeculectomy in 243 eyes. Acta Ophthalmol Scand. 1997; 75:581–3.

13. Park HJ, Weitzman M, Caprioli J. Temporal corneal phacoemulsification combined with superior trabeculectomy. A retrospective case-control study. Arch Ophthalmol. 1997; 115:318–23.

14. Yalvac I, Airaksinen PJ, Tuulonen A. Phacoemulsification with and without trabeculectomy in patients with glaucoma. Ophthalmic Surg Lasers. 1997; 28:469–75.

15. Gous PN, Roux P. Preliminary report of sutureless phacotrabeculectomy through a modified self-sealing scleral tunnel incision. J Cataract Refract Surg. 1995; 21:160–9.

16. Wedrich A, Menapace R, Radax U, Papapanos P. Long-term results of combined trabeculectomy and small incision cataract surgery. J Cataract Refract Surg. 1995; 21:49–54.

17. Munden PM, Alward WL. Combined phacoemulsification, posterior chamber intraocular lens implantation, and trabeculectomy with mitomycin C. Am J Ophthalmol. 1995; 119:20–9.

18. Gedde SJ, Schiffman JC, Feuer WJ, et al. The Tube Versus Trabeculectomy Study: Design and baseline characteristics of study patients. Am J Ophthalmol. 2005; 140:275–87.

19. Gedde SJ, Schiffman JC, Feuer WJ, et al. Treatment outcomes in the Tube Versus Trabeculectomy Study after one year of follow-up. Am J Ophthalmol. 2007; 143:9–22.

20. Filippopoulos T, Rhee DJ. Novel surgical procedures in glaucoma: advances in penetrating glaucoma surgery. Curr Opin Ophthalmol. 2008; 19:149–54.

21. Palmer SS. Mitomycin as adjunct chemotherapy with trabeculectomy. Ophthalmology. 1991; 98:317–21.

22. Tsai HY, Liu CJ, Cheng CY. Combined trabeculectomy and cataract extraction versus trabeculectomy alone in primary angle-clo-sure glaucoma. Br J Ophthalmol. 2009; 93:943–8.

23. Noben KJ, Linsen MC, Zeyen TG. Is combined phacoemulsification and trabeculectomy as effective as trabeculectomy alone? Bull Soc Belge Ophthalmol. 1998; 270:85–90.

24. Guggenbach M, Mojon DS, Böhnke M. Evaluation of phacotrabeculectomy versus trabeculectomy alone. Ophthalmologica. 1999; 213:367–70.

25. Stewart WC, Crinkley CM, Carlson AN. Results of combined phacoemulsification and trabeculectomy in patients with elevated preoperative intraocular pressures. J Glaucoma. 1995; 4:164–9.

26. Derick RJ, Evans J, Baker ND. Combined phacoemulsification and trabeculectomy versus trabeculectomy alone: a comparison study using mitomycin-C. Ophthalmic Surg Lasers. 1998; 29:707–13.

27. Vass C, Menapace R. Surgical strategies in patients with combined cataract and glaucoma. Curr Opin Ophthalmol. 2004; 15:61–6.

28. Yang KJ, Jeong JH. Clinical study on combined phacoemulsification and intraocular lens implantation/trabeculectomy with mitomycin C. J Korean Ophthalmol Soc. 1996; 37:2065–72.

29. Bae JH, Nam H, Kwak DH. Corneal incision phacoemulsification and trabeculectomy combined surgery at separated site. J Korean Ophthalmol Soc. 1997; 38:105–10.

30. Park HS, Lee YG, Kim HK, Hong YJ. Combined phacoemulsification, posterior chamber lens implantation and trabeculectomy in advanced glaucoma patients. J Korean Ophthalmol Soc. 1997; 38:585–92.

31. Weinreb RN. Adjusting the dose of 5-fluorouracil after filtration surgery to minimize side effects. Ophthalmology. 1987; 94:564–70.

32. Andreanos D, Georgopoulos GT, Vergados J, et al. Clinical evaluation of the effect of mitomycin-C in reoperation for primary open angle glaucoma. Eur J Ophthalmol. 1997; 7:49–54.

33. You YA, Gu YS, Fang CT, Ma XQ. Long-term effects of simultaneous subconjunctival and subscleral mitomycin C application in repeat trabeculectomy. J Glaucoma. 2002; 11:110–8.

34. Baek CE, Kim JH, Sohn YH, et al. Effects of subconjunctival mitomycin C on glaucoma triple procedure, as compared with trabeculectomy alone. J Korean Ophthalmol Soc. 1997; 38:94–104.

35. Lochhead J, Casson RJ, Salmon JF. Long term effect on intraocular pressure of phacotrabeculectomy compared to trabeculectomy. Br J Ophthalmol. 2003; 87:850–2.

36. Kitazawa Y, Suemori-Matsushita H, Yamamoto T, Kawase K. Low-dose and highdose mitomycin trabeculectomy as an initial surgery in primary open-angle glaucoma. Ophthalmology. 1993; 100:1624–8.

37. Lyle WA, Jin JC. Comparison of a 3- and 6-mm incision in combined phacoemulsification and trabeculectomy. Am J Ophthalmol. 1991; 111:189–96.

38. Jun BS, Hong YJ, Kim CY. The surgical outcomes of combined phacoemulsification, posterior chamber lens implantation and trabeculectomy in glaucoma patients. J Korean Ophthalmol Soc. 2003; 44:357–64.

39. Cho YS, Choe YJ, Hong YJ. Trabeculectomy with mitomycin C(MMC). J Korean Ophthalmol Soc. 1995; 36:915–23.

40. Bagli E, Gartzios C, Asproudis I, Kitsos G. Comparison of one-site versus two-site phacotrabeculectomy without the use of anti-metabolites intraoperatively in patients with pseudoexfoliation glaucoma and primary open-angle glaucoma. Clin Ophthalmol. 2009; 3:297–305.

41. Borggrefe J, Lieb W, Grehn F. A prospective randomized comparison of two techniques of combined cataract-glaucoma surgery. Graefes Arch Clin Exp Ophthalmol. 1999; 237:887–92.

42. Rossetti L, Bucci L, Miglior S, Orzalesi N. Temporal corneal phacoemulsification combined with separate-incision superior trabeculectomy vs standard phacotrabeculectomy. A comparative study. Acta Ophthalmol Scand Suppl. 1997; 224:39.

43. el Sayyad F, Helal M, el-Maghraby A, et al. One-site versus 2-site phacotrabeculectomy: a randomized study. J Cataract Refract Surg. 1999; 25:77–82.

44. Wyse T, Meyer M, Ruderman JM, et al. Combined trabeculectomy and phacoemulsification: a one-site vs a two-site approach. Am J Ophthalmol. 1998; 125:334–9.