Long-term efficacy and safety of combined phacoemulsification plus trabeculectomy compared to trabeculectomy alone

Session Details

Session Title: Combined Cataract Surgery: Techniques/Practice Styles

Session Date/Time: Tuesday 13/09/2016 | 14:00-16:00

Paper Time: 14:12

Venue: Auditorium C6

First Author: : C.Kniestedt SWITZERLAND

Co Author(s): :    J. Wachtl   M. Toeteberg-Harms   S. Frimmel   N. Portmann           

Abstract Details

Purpose:

The aim of this study was to compare the long-term efficacy and safety of combined phaco-trabeculectomy (Phaco-Trab) and trabeculectomy alone (Trab) by means of intraocular pressure (IOP) reduction, decrease in number of hypotensive medications (AGD), numbers of postoperative interventions. We assume that, contrary to current opinion, combined Phaco-Trab is as effective as Trab in lowering IOP and AGD.

Setting:

University Hospital Zurich and Talacker Eye Center, Zurich, Switzerland.

Methods:

Retrospective comparative case series of consecutive patients after Phaco-Trab or Trab (01/2008 - 11/2009). All procedures were performed by one surgeon (CK). Primary outcome measures were change in IOP and AGD from baseline as well as the number of postoperative interventions needed. These included suturolysis, application of 5-Fluorouracil and needling. Secondary outcome measures were surgery-associated complications and visual acuity. Success was defined based on the criteria from the tube-versus-trabeculectomy study.

Results:

Phaco-Trab (n=62) decreased mean IOP from 23.6 mmHg to 13.0 mmHg at 1y and 13.5 mmHg at 4y. AGD were reduced from 2.45 to 0.07 at 1y and 0.23 drops at 4y. Trab (n=72) decreased mean IOP from 22.2 mmHg to 11.75 mmHg at 1y and 12.4 mmHg at 4y. AGD were reduced from 2.58 to 0.17 at 1y and 0.24 drops at 4y. All changes compared to baseline are highly significant (P<0.001). The mean number of postoperative interventions was 2.1 after Phaco-Trab and 1.8 after Trab, but fewer patients in the Phaco-Trab group needed postoperative interventions (74% vs. 85%).

Conclusions:

This study confirms the long-term efficacy and safety of combined Phaco-Trab if a close and consistent follow-up can be guaranteed. In contrast to previous studies, we found the combined procedure to reach equal surgical success as Trab alone. Thereby saving costs as well as exposing the patient to perioperative risk once only. This study endorses early Phaco-Trab in patients with concomitant cataract and glaucoma.

Financial Disclosure:

NONE