Combined phacoemulsification and trabeculectomy with mitomycin-C.
OBJECTIVE
To examine the safety and efficacy of primary combined phacoemulsification, posterior chamber intraocular lens (IOL) implantation, and trabeculectomy with mitomycin-C (0.4 mg/ml) in patients with open-angle glaucoma and visually significant cataract.


METHODS
University-hospital-based glaucoma referral practice.


METHODS
In this study, data of 43 patients of a single surgeon were retrospectively analyzed. These consecutive patients had combined phacoemulsification, posterior chamber IOL implantation, and trabeculectomy with mitomycin-C.


RESULTS
Thirty-eight patients (88%) had open-angle glaucoma and 5 (12%) pseudoexfoliative glaucoma. Thirty-eight patients (88%) had 12 months of follow-up; all had at least 6 months follow-up. Mean preoperative intraocular pressure (IOP) was 21.6 mm Hg +/- 6.8 (SD) (range 12.0 to 41.0 mm Hg) with 2.5 +/- 1.0 glaucoma medications. At last follow-up, mean IOP had decreased to 14.2 +/- 6.2 mm Hg (range 3.0 to 40.0 mm Hg) with 0.5 +/- 0.5 glaucoma medications. Twenty-one patients (55%) had an IOP of 15 mm Hg or less at 12 months. Best corrected visual acuity was 20/40 or better in 31 of 43 patients (72%) at last follow-up. A filtration bleb was noted in 33 of 40 patients (83%) at their last visit. Postoperative IOP spikes occurred in 17 patients (40%), transient hyphema in 12 (28%), transient wound leaks in 11 (26%), and superficial punctate keratopathy in 11 (26%). Three cases of persistent hypotony (IOP less than 5 mm Hg) and 1 case of epithelial downgrowth were also noted.


CONCLUSIONS
Phacoemulsification with IOL implantation and combined trabeculectomy with mitomycin-C produced good visual acuity and excellent IOP control but resulted in some complications. The use of mitomycin-C in combined procedures does not appear to confer a significant benefit.
Ruderman
J M
JM
Department of Ophthalmology, North-western University Medical School, Chicago, Illinois 60611-1210, USA.
Fundingsland
B
B
Meyer
M A
MA
D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007429:Intraocular Pressure; D007910:Lenses, Intraocular; D016685:Mitomycin / Q000627:therapeutic use*; D018918:Phacoemulsification / Q000379:methods*; D011183:Postoperative Complications; D012189:Retrospective Studies; D014130:Trabeculectomy / Q000379:methods*; D016896:Treatment Outcome; D014792:Visual Acuity
D000903:Antibiotics, Antineoplastic; D016685:Mitomycin