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Phaco plus microtrabeculectomy controls IOP similarly to microtrabeculectomy alone, study finds

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Performing small-flap trabeculectomy, or microtrabeculectomy, combined with phacoemulsification appears to control IOP as effectively as microtrabeculectomy alone, according to a study by researchers in the United Kingdom. At final follow-up, there was no significant difference in survival rates between the treatment groups for target IOPs, the authors noted.

Alan P. Rotchford, MD, FRCOphth, and Stephen A. Vernon, DM, FRCOphth, reviewed outcomes for 37 consecutive low-risk patients who underwent phacoemulsification combined with microtrabeculectomy. They compared these patients with a similar group of 37 low-risk patients who underwent microtrabeculectomy alone.

In all cases, microtrabeculectomy was augmented with 5-fluorouracil, according to the study.

Follow-up averaged 41.7 months in the phaco-microtrabeculectomy group and 43.5 months in the microtrabeculectomy-only group.

Control of IOP was compared between groups by survival analysis, with target pressures of 21 mm Hg or less and 16 mm Hg or less at final follow-up and with at least a 25% reduction from the preoperative IOP, according to the study.

Among patients treated with phaco-microtrabeculectomy, 91.9% achieved a final IOP of 21 mm Hg or less with at least a 25% reduction in their preoperative IOP; 70.3% achieved this target without additional use of glaucoma drops.

Also in the phaco-microtrabeculectomy group, 67.6% of patients achieved a final IOP of 16 mm Hg or less with at least a 25% reduction in preoperative IOP; 56.8% achieved this target without using additional glaucoma drops, the authors reported.

"There were no significant differences in survival rates between [phaco-microtrabeculectomy] and [microtrabeculectomy] for either IOP target," they said.

Final IOP averaged 13.4 mm Hg in the phaco-microtrabeculectomy group, with patients using an average of 0.6 glaucoma drops. In the microtrabeculectomy-only group, final IOP averaged 13.5 mm Hg, with patients using an average of 0.8 glaucoma drops, according to the study.

Final visual acuity improved by at least one line in 81.1% of patients in the phaco-microtrabeculectomy group, the authors noted.

The study is published in the December issue of Clinical & Experimental Ophthalmology.