Aims: To compare the long-term efficacy and safety of combined trabeculectomy and cataract extraction versus trabeculectomy alone in primary angle-closure glaucoma (PACG).
Methods: Hospital files were retrospectively examined for 99 Chinese PACG patients; 75 patients underwent combined surgery and 24 underwent trabeculectomy alone. We assessed success rates with the Kaplan-Meier survival analysis. The main outcome was the complete success rate defined as either a >20% reduction of intraocular pressure (IOP) or an IOP that remained below 15 mmHg, with no medications required.
Results: Patients in the combined group and trabeculectomy group had a mean follow-up period of 25.8+/-10.8 months and 31.4+/-8.9 months, respectively. Survival analysis showed that the complete success rate at three years was 56% in the combined group and 54% in the trabeculectomy group (P =0.903). There were no significant differences between groups in either IOP or the number of glaucoma medications throughout the three year follow-up. The incidence of postoperative complications were similar between groups (P =0.929). No additional IOP-lowering surgical procedures were required in the combined group, while 13 (54%) eyes in the trabeculectomy group required either cataract extraction or further IOP-lowering surgical procedures (P <0.001).
Conclusion: In patients with PACG, the long-term IOP-lowering effect and surgical complications of combined trabeculectomy and cataract extraction are comparable to those of trabeculectomy alone. However, the combined surgery incurred fewer subsequent surgical interventions.