Comparative outcomes of phaco-trabeculectomy versus phaco-tube implantation: a 6-year review

Combined cataract and glaucoma surgeries are common in patients diagnosed with both visually significant cataract and uncontrolled intraocular pressure (IOP). Although phacoemulsification with Ahmed glaucoma valve (phaco-AGV) implantation and phacoemulsification with trabeculectomy (phaco-trab) are established surgical options, limited data are available on their long-term comparative outcomes, particularly in large patient cohorts. A retrospective cohort study involving 249 eyes of patients who underwent either phaco-AGV (n = 120) or phaco-trab (n = 129) procedures at a tertiary eye center was conducted. Patients were followed for up to 6 years after surgery. The primary outcome measure was surgical success, defined as an IOP between 6 and 21 mmHg with or without glaucoma medications and without further glaucoma surgery or light perception vision loss. Secondary outcomes included IOP level, number of glaucoma medications, best-corrected visual acuity (BCVA), and postoperative complications. Surgical outcomes were analyzed using Kaplan‒Meier survival curves, and chi‒square and ANOVA tests were used to assess differences between the two groups. At the final follow-up, the cumulative probability of surgical success was slightly greater in the phaco-trab group than in the phaco-AGV group (59.9% vs. 40.1%, P < 0.001). The mean IOP was significantly lower in both groups at the final follow-up than at baseline (p < 0.001), with comparable final IOP levels. The mean number of glaucoma medications was significantly lower in the phaco-trab group than in the phaco-AGV group (p < 0.05). Postoperative complications were more frequent in the phaco-AGV group (32.5%) than in the phaco-trab group (16.3%) (p = 0.003). Visual acuity improvements were comparable between the groups. Both the phaco-AGV and phaco-trab procedures effectively reduced IOP and improved visual acuity in patients with coexisting cataract and glaucoma. However, phaco-trab was associated with a lower rate of postoperative complications and required fewer long-term glaucoma medications. These findings suggest that while both procedures are viable options, phaco-trab, compared with phaco-AGV, may offer a more favorable risk‒benefit profile across an extended follow-up.