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Study shows combined procedures lower long-term IOP
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DANA POINT, Calif. — Combined phacoemulsification and trabeculectomy lower long-term intraocular pressure more effectively than cataract surgery procedures alone, a comprehensive literature review showed.
These findings were presented by David S. Friedman, MD, MPH, here at the Sixth Annual Ocular Drug & Surgical Therapy Update. The review covered short- and long-term IOP control in cataract and trabeculectomy surgeries.
Researchers found strong evidence that combined procedures lower long-term IOP more than cataract surgery alone. There was moderate evidence that trabeculectomy alone lowers IOP long-term more than combined extracapsular cataract extraction and trabeculectomy.
There was weak evidence that extracap alone raises IOP on the first postoperative day and that extracap or phaco combined with glaucoma procedure lowers IOP 24 hours after surgery.
In phaco with pre-existing blebs, four out of five articles found no decrease in function. One case-control study found similar rates of bleb survival, and one article reported high rates of bleb failure.
In comparing surgical techniques, researchers found moderate evidence that mitomycin-C increases the success rate in combined procedures, 5-fluorouracil does not improve the IOP-lowering effect of combined procedures, and limbus- and fornix-based combined procedures are equal in effectiveness.
Researchers also found that there is good evidence that trabeculectomy leads to cataract. There was a 38% incidence of cataract in patients who underwent trabeculectomy compared with 14% in non-trabeculectomy glaucoma treatment, Dr. Friedman said.
The Sixth Annual Ocular Drug & Surgical Therapy Update Meeting is a CME activity sponsored by SLACK Incorporated and supported through an unrestricted grant from Allergan.