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Keywords:

  • cataract extraction;
  • filtering surgery;
  • 5-fluorouracil;
  • glaucoma;
  • trabeculectomy

Abstract

Purpose:  To describe a modified technique for combined cataract and glaucoma drainage surgery involving a small flap (micro) trabeculectomy combined with phaco-emulsification (PMT). To assess the level of intraocular pressure (IOP) control achieved by this procedure in comparison with microtrabeculectomy (MT) alone.

Methods:  In this retrospective controlled case series records were reviewed for 37 consecutive low-risk patients undergoing PMT augmented with 5-fluorouracil (5-FU) and 37 low-risk subjects undergoing MT with 5-FU. IOP control was compared by survival analysis using IOP targets ≤21 mmHg and ≤16 mmHg at final follow up and with at least a 25% reduction from the preoperative pressure.

Results:  Mean follow up was 41.7 months (range 19.0–72.0) in the PMT group and 43.5 months (range 18.0–66.0) in the MT group. A final IOP ≤ 21 mmHg and with at least a 25% reduction from the preoperative pressure was achieved in 91.9% patients undergoing PMT (70.3% on no glaucoma drops). IOP <= 16 mmHg and with at least a 25% reduction from the preoperative pressure was achieved in 67.6% (56.8% without drops). There were no significant differences in survival rates between PMT and MT for either IOP target. The mean final IOPs were 13.4 and 13.5 mmHg on a mean of 0.6 and 0.8 glaucoma drops in the PMT and MT groups, respectively. In the PMT final visual acuity improved by at least one Snellen line in 81.1% and was worse in a single eye.

Conclusions:  IOP control following combined surgery by PMT is as good as following MT alone.