Trabeculectomy combined with phacoemulsification and intraocular lens implantation

It has recently become popular to use mitomycin C (MMC) with trabeculectomy. MMC helps to maintain effective filtration and long-term intraocular pressure (IOP) control, while the use of laser suture lysis has improved the safety of this procedure. We evaluated the outcome of trabeculectomy alone and of trabeculectomy plus phacoemulsification (PEA) and intraocular lens (IOL) implantation, each supplemented with MMC. The mean preoperative IOP for the trabeculectomy alone group was 22.4 ± 3.2 mmHg(bleb+), 25.3 ± 2.6 mmHg(bleb−), and that of the combined surgery group was 22.4 ± 2.8 mmHg(bleb+), 21.0 ± 3.5 mmHg(bleb−). Mean postoperative IOP for the two groups were 13.3 ± 2.7 mmHg(bleb+), 17.1 ± 4.4 mmHg(bleb−) and 11.9 ± 2.7 mmHg(bleb+), 16.4 ± 3.4 mmHg(bleb−), respectively. After 4.5 years, the success probability for postoperative IOP control was 38%(bleb+), 3%(bleb−) in the trabeculectomy alone group and 53%(bleb+), 10%(bleb−) in the combined surgery group (≤⃒12 mmHg) and 65%(bleb+), 3%(bleb−) and 75%(bleb+), 10%(bleb−) (≤⃒14 mmHg)(Kaplan-Meier survival rate). With early complications, the frequency of shallow anterior chamber and choroidal detachment were significantly fewer in the combined surgery group. The combined surgery of PEA, IOL implantation and trabeculectomy is an effective procedure that offers visual rehabilitation, fewer early complications and good IOP control in patients with advanced, medically uncontrolled glaucoma and cataract.