Phaco-trab, phaco-AIT yield similar outcomes up to 2 years

SEATTLE — Up to 2 years, patient outcomes were comparable after phacoemulsification trabeculectomy, or phaco-trab, or after phacoemulsification ab interno trabeculectomy, or phaco-AIT, according to a speaker here. After 2 years, however, phaco-trab success was greater.

“We hypothesized that there would be a greater effect or success rate with the phaco-trab but enhanced safety with phaco-AIT,” Douglas J. Rhee, MD, said at the Association for Research in Vision and Ophthalmology meeting.

In a retrospective study of patients with open-angle glaucoma, 50 patients underwent phaco-trab and 156 patients underwent phaco-AIT. Eyes were chosen for a combined procedure if IOP was controlled but required more than three anti-glaucoma medications or if IOP was not in target range.

Using TVT criteria for success, phaco-trab patients had a lower IOP throughout all time points from 3 months to 3 years, Rhee said. There were no differences in intraoperative complications between the groups, and the complications that did occur intraoperatively were mostly related to phacoemulsification, Rhee said.

When microhyphema was excluded as a complication, however, then phaco-trab had a statistically significantly greater early complication rate, Rhee said.

Both phaco-trab and phaco-AIT reduced IOP and the number of glaucoma medications needed. Success rates remained similar for about 2 years, but after that, the phaco-AIT success rate was lower. Patients in the phaco-trab group had lower overall IOP and needed fewer medications, according to Rhee.

“However, lowering intraocular pressure does come at a cost,” Rhee said. “There was a higher complication rate with phaco-trab.”

Disclosure: Rhee is a consultant for or receives financial support from Alcon, AqueSys, Merck and Santen.