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

Yun Jeong Choi; Douglas J. Rhee; Kyu-Ryong Choi

doi:10.3341/jkos.2011.52.11.1308

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Choi, Rhee, and Choi: Treatment Outcome of Phacotrabeculectomy and Trabeculectomy in Patients with Cataracts and Glaucoma

Original Article

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

Published online: 7 September 2011

DOI: https://doi.org/10.3341/jkos.2011.52.11.1308

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

Yun Jeong Choi, MD¹, Douglas J. Rhee, MD, PhD², Kyu-Ryong Choi, MD, PhD^1,²

¹Department of Ophthalmology, Institute of Ophthalmology and Optometry, Ewha Womans University Medical Center, Seoul, Korea

²Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA

Address reprint requests to Kyu-Ryong Choi, MD, PhD Department of Ophthalmology, Ewha Womans University Mok-dong Hospital #911-1 Mok-dong, Yangcheon-gu, Seoul 158-710, Korea Tel: 82-2-2650-5154, Fax: 82-2-2654-4334, E-mail: ckrey02@ewha.ac.kr

Received 23 December 2010 Revised 14 April 2011 Accepted 30 August 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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 post-operatively 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.

Keywords: Cataract, Glaucoma, Mitomycin, Phacotrabeculectomy, Trabeculectomy

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Figure 1.

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

Table 1.

Baseline characteristics of patients

	Phacotrabeculectomy group (n = 27)	Trabeculectomy group (n = 29)	p-value
Age (mean ± SD, yr)	74.1 ± 8.9	63.3 ± 17.0	0.01^*
Sex, n (%)			0.11^†
Male	15 (55.6)	10 (34.5)	
Female	12 (44.4)	19 (65.5)	
Diabetes mellitus, n (%)	10 (37.0)	10 (34.5)	0.84^†
Hypertension, n (%)	18 (66.7)	13 (44.8)	0.10^†
IOP (mean ± SD, mm Hg)	23.4 ± 7.1	27.8 ± 8.1	0.02^*
Glaucoma medication (mean ± SD)	2.9 ± 1.0	3.3 ± 1.0	0.16^*
Diagnosis, n (%)			0.82^†
POAG	14 (51.9)	15 (51.7)	
CACG	5 (18.5)	3 (10.3)	
PXFG	3 (11.1)	4 (13.8)	
Other	5 (18.5)	7 (24.2)	
Snellen VA (mean ± SD, log MAR)	0.8 ± 0.8	0.4 ± 0.5	0.03^*
Mean deviation (mean ± SD, dB)	−11.2 ± 7.1	−10.4 ± 6.8	0.77^*
Follow up (mean ± SD, mon)	23.1 ± 14.0	20.5 ± 8.3	0.76^*

CACG = chronic angle-closure glaucoma; IOP = intraocular pressure; POAG = primary open-angle glaucoma; PXFG = pseudoexfoliation glaucoma; SD = standard deviation; VA = visual acuity.

^* Mann-Whitney U test

^† Chi-square test.

Table 2.

Intraocular pressure and number of glaucoma medications at baseline and follow-up in phacotrabeculectomy and trabecu-ectomy groups

	Phacotrabeculectomy group	Trabeculectomy group	p-value^*
Baseline			
IOP (mm Hg)	23.4 ± 7.1	27.8 ± 8.1	0.02
Medication (n)	2.9 ± 1.0	3.3 ± 1.0	0.16
1 day			
IOP (mm Hg)	17.4 ± 8.2 (25.6)^†	17.7 ± 8.1 (36.3)^†	0.77
1 week			
IOP (mm Hg)	15.0 ± 5.9 (35.9)^†	16.0 ± 9.7 (42.4)^†	0.91
Medication (n)	0.4 ± 0.7 (86.2)^†	0.0 ± 0.0 (100)^†	0.02
1 month			
IOP (mm Hg)	14.3 ± 4.8 (38.9)^†	11.3 ± 6.0 (59.4)^†	0.02
Medication (n)	0.4 ± 0.9 (86.2)^†	0.0 ± 0.0 (100)^†	0.01
3 months			
IOP (mm Hg)	15.8 ± 6.0 (32.5)^†	12.1 ± 5.2 (56.5)^†	0.03
Medication (n)	0.7 ± 1.0 (75.9)^†	0.4 ± 1.0 (87.9)^†	0.11
6 months			
IOP (mm Hg)	13.1 ± 3.8 (44.0)^†	11.1 ± 5.0 (60.1)^†	0.12
Medication (n)	1.3 ± 1.2 (55.2)^†	0.6 ± 1.2 (81.8)^†	0.02
12 months			
IOP (mm Hg)	13.1 ± 3.5 (44.0)^†	11.5 ± 4.5 (58.6)^†	0.33
Medication (n)	1.7 ± 1.3 (41.4)^†	0.8 ± 1.4 (75.8)^†	0.03
18 months			
IOP (mm Hg)	14.7 ± 2.4 (37.2)^†	12.8 ± 5.6 (63.0)^†	0.18
Medication (n)	1.7 ± 1.3 (41.4)^†	0.9 ± 1.4 (62.8)^†	0.09
24 months			
IOP (mm Hg)	13.3 ± 3.7 (43.2)^†	12.9 ± 5.3 (53.6)^†	0.89
Medication (n)	1.6 ± 1.2 (44.8)^†	1.3 ± 1.4 (60.6)^†	0.45

Data are presented as mean ± standard deviation (percentage of reduction).

IOP = intraocular pressure.

^* Mann-Whitney U test

^† Statistically significant change compared to baseline (Wilcoxon signed rank test).

Table 3.

Treatment outcomes in the phacotrabeculectomy and trabeculectomy groups at 24 months after surgery

	Phacotrabeculectomy group (n = 27)	Trabeculectomy group (n = 29)	p-value^*
Failure	8 (29.6)^†	8 (27.6)^‡	0.87
Success	19 (70.4)	21 (72.4)	0.87
Qualified	12 (44.5)	9 (31.0)	0.20
Complete	7 (25.9)	12 (41.4)	0.20

Data are presented as number (percentage).

^* Chi-square test

^† Failure due to inadequate IOP control (8 eyes)

^‡ Failure due to inadequate IOP control (5 eyes), persistent hypotony (2 eyes), and loss of light perception (1 eye).

Table 4.

Comparison of the early and late postoperative complications between the phacotrabeculectomy and trabeculectomy groups

	Phacotrabeculectomy group (n = 27)	Trabeculectomy group (n = 29)
Early complications (≤ 4 weeks after surgery)		
Day 1 IOP spike	4 (14.9)	4 (13.8)
Hyphema	3 (11.1)	1 (3.4)
Corneal edema	4 (14.9)	1 (3.4)
A/C shallowing (requiring reformation)	0	1 (3.4)
Conjunctival wound leak		
Healed with conservative measures	4 (14.9)	6 (20.7)
Require suturing	0 (0.0)	1 (3.4)
Choroidal detachment	2 (7.4)	3 (10.3)
Hypotonous maculopathy	0 (0.0)	1 (3.4)
Late complications (>4 weeks after surgery)		
Hypotonous maculopathy	0 (0.0)	1 (3.4)
Choroidal detachment	0 (0.0)	1 (3.4)
Posterior capsular opacity	8 (29.6)	−
Endophthalmitis	0 (0.0)	0 (0.0)

Data are presented as number (percentage).

A/C = anterior chamber; IOP = intraocular pressure.

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