Phacotrabeculectomy and Implantation of Intraocular Lenses with Releasable Sutures and Antimetabolite Agents: Efficacy and Safety

Abstract Background: The aim of this study was to evaluate the efficacy and safety of phacoemulsification and the implantation of intraocular lenses (IOL) combined with trabeculectomy supplemented by releasable sutures and antimetabolite agents. Methods:Phacotrabeculectomy was performed in 36 eyes of 30 patients who hadmedically uncontrolled Intraocular pressure (IOP) or were nonreliable for medical therapy and had significant cataract, or had low Visual Activity (VA) due to cataract and simultaneous uncontrolled or medically controlled IOP with at least 2 medications.  Mitomycin C (0.02%) for 1-3 minutes was applied in all cases. Scleral flap was sutured with permanent (loose) and releasable (tight) 10-0 nylon sutures. The releasable sutures were removed in the first to third postoperativeweeksif IOP was more than 12mmHg. If bleb was vascularized or flat, and IOP was high or borderline (>16mmHg), 5FU was injected subconjunctivally 1-3 weeks after the surgery. If postoperative IOP was more than target pressure, antiglaucoma medications were used. Results:Eight eyes (22.2%) required releasable suture removal. Mean preoperative IOP was 28.4±9.4 (12-52) mmHg. Totally, 33 eyes (91.7%) had primary open angle glaucoma, two eyes (5.5%) had posttraumatic glaucoma and one eye (2.8%) had exfoliative glaucoma (XFG). Mean postoperative final IOP was 12.1±3.9 (5-22) mmHg (P<0.0001). Preoperative VA was 0.5mCF (log Mar=2) to 20/200 (log Mar=1). Mean VA was 3mC.F (Log Mar=1.3±0.4). Postoperative VA was 20/200 (log Mar=1) to 20/20 (log Mar=0) and mean postoperative VA was 20/60 (log Mar=0.57±0.46) (P<0.0001). Mean number of required medications to control IOP was 2.58±0.09 (2-4) preoperatively and 0.58±0.15 (0-3) postoperatively (p<0.0001). Early postoperative complications were flat anterior chamber in 3 eyes (8.3%), postoperative uveitis in 3 eyes (8.3%) leakage in 3 eyes (8.3%) and choroidal effusion in 1 eye (2.8%). Conclusion: It seems, this method is an effective and safe procedure for patients with coexisting cataract and glaucoma.