One- and two-site phacotrabeculectomy show similar efficacy at 3 years

Performing phacotrabeculectomy using either a one-site or two-site approach appears similarly effective for lowering IOP and reducing the need for antiglaucoma medications at 3 years postop, according to results of a prospective, randomized study.

Paul R. Cotran, MD, and colleagues at Lahey Clinic in Burlington, Mass., and at the University of Alabama at Birmingham compared IOP stability and other clinical outcomes between phacotrabeculectomy performed with a single-site fornix-based approach or two-site limbus-based approach. They published their results in the March issue of Ophthalmology.

The study included 90 eyes of 76 patients with both cataract and glaucoma. Investigators randomly assigned 44 eyes to undergo single-site phacotrabeculectomy and 46 eyes to undergo two-site surgery.

Surgeons performed all procedures with the adjunctive use of topical mitomycin-C, the authors noted.

Preoperatively, IOP averaged 20.1 mm Hg in the one-site group and 19.5 mm Hg in the two-site group. Both groups used a similar number of antiglaucoma medications.

At 3 years follow-up, IOP averaged 12.6 mm Hg in the single-site group and 11.7 mm Hg in the two-site group. Also, the number of glaucoma medications used decreased to an average of 0.3 in the single-site group and 0.4 in the two-site group, according to the study.

"There were no significant differences in the need for digital pressure, postoperative bleb needling with 5-fluorouracil or number of postoperative visits," the study authors said.

Each group had two major complications during 3-year follow-up. But early conjunctival wound leaks occurred only in six eyes in the single-site group and no eyes in the two-site group (P = .03).

At final follow-up, 73% of eyes in the one-site group and 78.4% of eyes in the two-site group had IOP lower than 18 mm Hg without using antiglaucoma medications, the authors noted.