Risk factors for unsatisfactory intraocular pressure control in combined trabeculectomy and cataract surgery.
OBJECTIVE
Trabeculectomy combined with posterior chamber intraocular lens (PC IOL) insertion is often chosen for the treatment of glaucoma combined with cataract. In this study, the clinical prognostic indicators for late intraocular pressure (IOP) control in combined procedures were investigated.


METHODS
The clinical records of 60 eyes that underwent trabeculectomy combined with PC IOL implantation were retrospectively analyzed using the Cox proportional hazards model. All of the patients received postoperative 5-fluorouracil injections.


RESULTS
Extracapsular cataract extraction (ECCE) was found to be a statistically significant risk factor for unsatisfactory late IOP control (hazard ratio 2.54; P < .01) and for unsatisfactory filtering bleb appearance (hazard ratio 5; P < .001). The frequency of fibrin formation and the incidence of a transient IOP spike (> or = 25 mm Hg) were significantly lower in the phacoemulsification and aspiration (PEA) group than in the ECCE group. In the PEA group, the probability of IOP control (< or = 15 mm Hg) without medication was 54%, and the probability of persistent filtering bleb appearance was 80% at 18 months.


CONCLUSIONS
The PEA technique, not ECCE, should be employed in combined trabeculectomy and PC IOL implantation.
Yamagami
S
S
Department of Ophthalmology, University of Tokyo School of Medicine, Japan.
Hamada
N
N
Araie
M
M
Shirato
S
S
D000368:Aged; D000369:Aged, 80 and over; D000963:Antimetabolites / Q000008:administration & dosage / Q000627:therapeutic use; D002386:Cataract / Q000150:complications; D002387:Cataract Extraction; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000627:therapeutic use; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D007910:Lenses, Intraocular; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D012189:Retrospective Studies; D012307:Risk Factors; D014065:Tonometry, Ocular / Q000379:methods; D014130:Trabeculectomy
D000963:Antimetabolites; D005472:Fluorouracil