Intraocular pressure control after combined phacotrabeculectomy versus trabeculectomy alone

PURPOSE: We compared the efficacy and safety of trabeculectomy and phacotrabeculectomy in patients with glaucoma.MATERIALS AND METHODS: We retrospectively analyzed consecutive patients who underwent trabeculectomy or phacotrabeculectomy. Patients in the trabeculectomy group were pseudophakic. We established three different intraocular pressure (IOP) thresholds (A: <21mmHg, B: <18mmHg, and C: <15mmHg) to measure complete (without medication) and qualified (with medication) success. Success criteria were analyzed through Kaplan-Meier survival curves.RESULTS: Sixty-seven eyes were included (40 trabeculectomy, 27 phacotrabeculectomy). The mean follow-up period was 25.70±14.439months. The baseline characteristics were similar between the groups. The complete and qualified success rates according to criterion C were significantly higher in the trabeculectomy group (p=0.033, p=0.021, respectively); however, there was a trend toward a higher success rate for all criteria in favor of trabeculectomy. Bleb needling was more frequent in the phacotrabeculectomy group. The mean IOP significantly decreased from 26.46±7.07 to 12.27±4.06 at 12months (p<0.001). The final mean IOP was significantly lower in the trabeculectomy than in the phacotrabeculectomy group (10.95±3.08 vs 13.00±4.56, p=0.0003).CONCLUSION: In pseudophakic eyes, trabeculectomy alone achieves a higher success rate, lower mean IOP, and less frequent bleb needlings. More frequent follow-up and prolonged postoperative use of high-dose topical steroids should be considered in patients undergoing phacotrabeculectomy.