A prospective randomized comparison of two techniques of combined cataract – glaucoma surgery

Abstract 

· Background: Small-incision cataract surgery combined with trabeculectomy offers new options for surgical treatment of patients with glaucoma and cataract. The purpose of this prospective randomized study was to compare the efficacy and safety of two different techniques of combined surgery: a one-site and a two-site approach. · Methods: Fifty eyes of 50 patients were included in this study. Twenty-five patients were randomly assigned to the one-site procedure and 25 patients to the two-site procedure. The one-site approach consisted of a superior tunnel phacoemulsification under a scleral flap with subsequent trabeculectomy. The two-site approach included a temporal corneal phacoemulsification combined with a separate-incision superior trabeculectomy. · Results: The preoperative mean intraocular pressure (IOP) of 29.8±4.9 mmHg dropped significantly to 15.9±3.2 mmHg. The mean follow-up time was 19±4.3 months (range 4–25 months). The reduction of IOP was more pronounced in the two-site group (50.1%) than in the one-site group (43%), but the difference was not statistically significant. Patients needed 2.2±1.7 antiglaucomatous medications preoperatively vs 0.52±1.39 postoperatively. Three patients (6%) required needling of encapsulated bleb, and two patients underwent a reoperation to control IOP. Mean visual acuity improved from 0.14±0.36 to 0.38±0.30 postoperatively. The most common complications after combined surgery were fibrinous exudation (24%) and hyphema (12%). · Conclusion:Both techniques of combined cataract and glaucoma surgery proved to be efficient and safe procedures to control IOP and to improve visual acuity. The reduction of IOP did not differ between the one-site approach and the two-site approach.