title: Prospective intrapatient comparison of extracapsular cataract extraction and lens implantation with and without trabeculectomy.
abstract: OBJECTIVE
  To determine whether extracapsular cataract extraction and posterior chamber lens implantation combined with trabeculectomy provides better long-term results than extracapsular cataract extraction and lens implantation alone in a group of patients with primary open-angle glaucoma and cataract.
  
  
  METHODS
  In a prospective, randomized clinical trial, 35 patients with bilateral, symmetric, primary open-angle glaucoma and visually disabling cataracts were randomly selected to undergo surgery with trabeculectomy in one eye and without in the other. All procedures were performed by a single surgeon in a private practice setting with follow-up for more than 5 years in all cases.
  
  
  RESULTS
  After an average of 87 months of follow-up, extracapsular cataract extraction and posterior chamber lens implantation reduced intraocular pressure by 4.4 +/- 3.3 mm Hg, reduced the number of medications by 1.28 +/- 0.86, increased diopter vector of astigmatism by 1.49, and was associated with visual field loss in six of 35 eyes. After an average of 80 months of follow-up, extracapsular cataract extraction and posterior chamber lens implantation with trabeculectomy reduced intraocular pressure by 8.2 +/- 4.6 mm Hg (P =.0001), reduced the number of medications by 1.76 +/- 0.82 (P=.0002), increased diopter vector of astigmatism by 1.14, and was associated with visual field loss in one eye (P =.05). Both groups had similar improvement in visual acuity and perioperative complications.
  
  
  CONCLUSIONS
  Extracapsular cataract extraction and posterior chamber lens implantation with trabeculectomy was beneficial in the long-term control of intraocular pressure and in prevention of visual field loss. This procedure should be considered for patients in whom long-term pressure control at a lower level would be beneficial in preventing further optic nerve damage.
authors.affiliation: Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St Louis, MO, USA. bobrowj@pol.net
authors.forename: J C
authors.initials: JC
authors.lastname: Bobrow
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002386:Cataract / Q000150:complications*; D002387:Cataract Extraction / Q000379:methods*; D005260:Female; D005902:Glaucoma, Open-Angle / Q000150:complications*; D006801:Humans; D007429:Intraocular Pressure; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D009901:Optic Nerve Diseases / Q000517:prevention & control; D011446:Prospective Studies; D014130:Trabeculectomy / Q000379:methods*; D014786:Vision Disorders / Q000517:prevention & control; D014792:Visual Acuity; D014794:Visual Fields