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The safety and efficacy of combined phacoemulsification and trabeculectomy with releasable sutures
  1. W J Stark,
  2. R K Goyal,
  3. O Awad,
  4. E Vito,
  5. A C Kouzis
  1. Wilmer Eye Institute, The Johns Hopkins University, School of Medicine, Baltimore, MD, USA
  1. Correspondence to: Dr Walter J Stark 600 N Wolfe Street, Maumenee 327, Baltimore, MD 21287, USA; wstark{at}jhmi.edu

Abstract

Aim: To evaluate the combined phacoemulsification with acrylic intraocular lens implantation and trabeculectomy with releasable sutures, without the use of antimetabolites, performed by one surgeon.

Methods: A retrospective analysis was performed on 251 eyes of 198 patients after a combined phaco/trabeculectomy procedure, followed up for an average of 16 months for vision, intraocular pressure (IOP), and number of glaucoma medications. Cox proportional hazard regression analysis provided measures of relative risk (RR) or hazards ratios and 95% confidence intervals (CIs) associated with the occurrence of several conditions or complications of surgery.

Results: Mean preoperative variables were best corrected vision, 0.6 (SD 0.4) logMAR (20/80 Snellen); IOP, 18.7 (4.9) mm Hg; and number of glaucoma medications, 1.7 (0.8). Mean postoperative results were best corrected vision, 0.2 (0.4) logMAR (20/32 Snellen); IOP, 15.1 (3.2) mm Hg; and number of glaucoma medications, 0.3 (0.6). Postoperatively, the mean decreases from baseline were 19.2% for IOP and 84.1% for number of glaucoma medications; 85% of eyes required fewer glaucoma medications and 78% of eyes were medication free, with IOP control. There were no significant operative or postoperative complications.

Conclusion: Combined phacoemulsification and trabeculectomy with releasable sutures, in the absence of antimetabolites, is a safe, effective, and stable alternative for patients with cataracts and glaucoma.

  • BCVA, best corrected visual acuity
  • CI, confidence intervals
  • 5-FU, 5-fluorouracil
  • IOP, intraocular pressure
  • MMC, mitomycin C
  • RR, relative risk
  • phacoemulsification
  • trabeculectomy

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