Surgeon recommends doing phaco before trabeculectomy

GOIANIA, Brazil — In cases in which both phacoemulsification and trabeculectomy are indicated but trabeculectomy is not urgent, the glaucoma surgery should be performed later, a surgeon said here at the International Congress of Cataract and Refractive Surgery.

"The advantage of the simultaneous combined phacoemulsification and trabeculectomy procedure is that it can be economical and convenient to do it all at the same time," said João França Lopes, MD, of Brazil.

However, the combined phaco-trabeculectomy procedure has the disadvantage of being less effective in reducing IOP. "If the IOP can be controlled by the cataract surgery, we might not want to expose the patient to the many potential complications associated to trabeculectomy," he noted.

Dr. Lopes said that performing both surgeries may result in greater patient satisfaction due to the immediate additional improvement in visual acuity resulting from the phacoemulsification, as opposed to trabeculectomy alone. Both surgeries can also result in better control of IOP peaks compared with phaco alone.

"Phaco first and trabeculectomy second is preferred in phacolytic, phacomorphic and closed-angle glaucoma cases," he said. "When performed after phaco, trabeculectomy lowers the IOP more than the combined surgery, by about 3.5 mm Hg, and this difference may be significant for glaucoma patients." Therefore, he recommended doing separate procedures whenever possible.