Phacotrabeculectomy: Assessment of outcomes and surgical improvements

Purpose

To evaluate the outcomes and progress after phacotrabeculectomy at the same clinical setting and/or performed by the same surgeon over the past decade.

Setting

Eye Institute of Utah, Salt Lake City, Utah, USA.

Methods

This retrospective study included 60 eyes of 43 patients who had phacotrabeculectomy at a single institute between 1999 and 2005. A modified phacotrabeculectomy surgical technique was used that included a 2-site incision approach, fornix-based flap, use of mitomycin-C, acrylic intraocular lens implantation, sutured scleral and conjunctival flaps, and sutured temporal clear corneal incision.

Results

Over a mean 30-month follow-up, 57 of the 60 eyes (95%) achieved intraocular pressure (IOP) control (≤21 mm Hg) with or without medication. Thirty eyes (50%) had an IOP of 15 mm Hg or lower, and 34 (57%) had an IOP reduction of at least 30%. The IOP decreased from a preoperative mean of 23.1 mm Hg on a mean number of 1.67 glaucoma medications to a mean of 14.9 mm Hg on a mean of 0.23 medication at the final follow-up (P<.001 for IOP decrease and for reduction in number of medications). Fifty-two eyes (87%) obtained a best spectacle-corrected visual acuity of 20/40 or better. Dysesthetic blebs requiring surgical revision and bleb hemorrhage (each occurring in 2 eyes, 3.3%) were seen in this study, but not previous studies.

Conclusions

The surgical technique used in this study appears to be effective and superior to a previous technique at restoring visual acuity, lowering IOP, and reducing the postoperative complication rate. The observations are relevant in the context of improvements of technique over the past decade.