Phaco-Trabeculectomy Equals Trabeculectomy in Lowering IOP-A 4 Years Follow-Up Study

Objective: The aim of this study was to compare the long-term efficacy and safety of combined phacotrabeculectomy (phaco-trab) and trabeculectomy (trab) alone. Methods: Retrospective, non-randomized, interventional case series of phaco-trab and trab. Inclusion criteria were diagnosis of glaucoma for both plus vision impairing coexisting cataracts for phaco-trab. Primary outcome measures were change in intraocular pressure (IOP) and number of anti-glaucoma drugs (AGD) at 1 y and 4 ys after surgery, and postoperative interventions (i.e. laser suture lysis, 5-Fluorouracil injection, needling). Secondary outcome measures were visual acuity and complications. Success was defined based on the criteria from the tubeversus-trabeculectomy study. Results: Mean age was 73.6 ± 8.7 years (28% males; 51% right eyes). Median preoperative IOP was reduced from 22.8 mmHg to postoperative 13.0 mmHg at 1 y and to 14.0 mmHg at 4 ys after phaco-trab (n=62), or in trab alone (n=72) from 21.8 mmHg to 12.0 mmHg at 1 y and 4 ys. AGD were reduced from 2.5 ± 0.8 to 0.1 ± 0.3 1 y and 0.2 ± 0.6 4 ys after phaco-trab, and from 2.6 ± 1.0 to 0.2 ± 0.5 AGD 1 y and 4 ys after trab alone. Both IOP and AGD reduction were statistically indifferent between the groups at all time points. Mean number of postoperative interventions was 2.1 for phaco-trab and 1.8 for trab (p=0.64). 75% of phaco-trab and 74% of trab eyes fulfilled the criteria for complete success after 4 ys (p=0.844). Conclusion: Both procedures resulted in an equally successful and stable long-term reduction of IOP to the lower teens and AGD requirement, together with a good safety profile. The high number of postoperative interventions in both groups emphasizes the importance of a close follow-up. We therefore conclude that if a close and careful postoperative follow-up can be guaranteed, phaco-trabeculectomy should be the treatment of choice for patients with coexisting cataract and otherwise uncontrolled IOP.