outcomes of single-site phacotrabeculectomy with mitomycin c

purpose: to evaluate visual outcomes and intraocular pressure (iop) after single-site phacotrabeculectomy with mitomycin c in patients with senile cataract and primary open angle glaucoma (poag), pseudoexfoliative glaucoma (pxg), or chronic angle closure glaucoma (cacg). methods: in this retrospective study, patients older than 50 years who had significant cataracts (bcva £ 20/60) and uncontrolled poag, pxg, or pacg (iop > 21 mmhg with at least two anti-glaucoma medications) were enrolled. exclusion criteria included the presence of corneal pathologies, uveitis, diabetic retinopathy, neovascular or phacomorphic glaucoma, posterior segment pathologies, or a history of ocular trauma or intraocular surgery. preoperative examination included uncorrected and best-corrected visual acuity (ucva and bcva, respectively), slit lamp biomicroscopy, iop measurements, gonioscopy, and dilated funduscopy. the participants underwent single site phacotrabeculectomy with mitomycin c. postoperative follow-up examinations were scheduled on days 1, 3, 7, and 14, and months 1, 3 and every 3 months thereafter. in each follow-up examination, the patients were re-evaluated for bcva, iop, the number of anti-glaucoma medications if needed, appearance of the bleb, and postoperative complications. results: forty (24 right) eyes of 32 (12 female) patients with poag (15 eyes), pxg (18 eyes), or cacg (7 eyes) were enrolled. mean patient age was 73±9 (range, 46 to 88) years and the study groups were comparable in this regard (p=0.88). mean postoperative follow-up period was 13.1±9.5 months, raging from 1 to 40 months. of the participants, 6 had diabetes mellitus and 6 had systemic hypertension. mean preoperative bcva was 0.64±0.32 logmar (20/80) which improved to 0.38±0.19 logmar (20/50) postoperatively (p < 0.001). preoperatively, mean iop was 18.6±6.0 (range, 7 to 33) mmhg which was decreased to 12.3±3.0 (range, 6 to 17) mmhg postoperatively (p < 0.001).the pxg group demonstrated the highest reduction (p=0.001) and the poag group experienced the lowest reduction (p=0.021) in iop. at the last follow-up examination, the number of anti-glaucoma medications was reduced to 0.9±1.1, on average (p <0.001). the reduction in the number of medication was highest in the poag (2.1±1.1, p=0.001) and lowest in the cagc group (1.3±0.5, p=0.08). at final follow-up iop was controlled with no medications in 21 eyes (52.5%), with timolol in 8 eyes (20%), and with 2 or more medications in 11 eyes (27.5%). with respect to intra- and postoperative complications and the appearance of the bleb, the study groups were comparable. conclusion: one-site phacotrabeculectomy with mitomycin c is a safe and effective approach to decrease iop and improve bcva in patients with coexisting cataract and glaucoma.