Study: Combined phaco, trabeculectomy with MMC had better results than phaco alone

Ophthalmology. 2009;116(4):725-731.

Combining phacoemulsification and trabeculectomy in chronic angle-closure glaucoma patients with cataracts lowered pressure and reduced medical dependence more than phaco alone, a study found.

"Combined phacotrabeculectomy with adjunctive mitomycin C is more effective than phacoemulsification alone in controlling IOP in medically uncontrolled [chronic angle-closure glaucoma] eyes with coexisting cataract," the researchers said. "Combined phacotrabeculectomy is associated with more postoperative complications."

The prospective, randomized clinical trial examined 51 eyes of 51 patients who had medically uncontrolled chronic angle-closure glaucoma and coexisting cataracts. Patients were randomized into two groups: Group 1 had 27 eyes that underwent phaco alone, while group 2 had 24 eyes that had phacotrabeculectomy with MMC. The study's main outcome measures were IOP and need for glaucoma medication.

The study authors found that the combined phacotrabeculectomy procedure had a lower mean postoperative IOP than phaco alone at 3 months (14 mm Hg vs. 17 mm Hg, P = .01), 15 months (13.2 mm Hg vs. 15.4 mm Hg, P = .02) and 18 months (13.6 mm Hg vs. 15.9 mm Hg, P = .01).

In addition, there were 1.25 fewer topical glaucoma drugs needed in the combined phacotrabeculectomy group by 24 months postop than in the phaco alone group (P < .001).

Combined surgery had a higher rate of association with postop complications (P < .001), and patients in the phacotrabeculectomy group had a higher incidence of progression of optic neuropathy (P = .03) than patients in the phaco alone group.