[The long-term effect of phacoemulsification combined with trabeculectomy and intraoperative 5-fluorouracil in glaucoma patients].
OBJECTIVE
This study was designed to evaluate the long-term effect of phacoemulsification, lens implantation combined with trabeculectomy augmented with 5-Fluorouracil (phaco-trab-5-Fu) in Asian glaucoma patients with primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG).


METHODS
This retrospective study included 71 consecutive patients who underwent phaco-trab-5-Fu in Singapore National Eye Center between January 1996 and December 1998. Patients with follow-up time less than 6 months were excluded from the study.


RESULTS
The mean follow-up time was (53.1 +/- 20.9) months. Postoperative IOP was significantly lower than preoperation [(15.0 +/- 4.0) mmHg (1 mmHg = 0.133 kPa), (20.3 +/- 5.4) mmHg, respectively, P < 0.01]. Postoperative number of antiglaucoma medications was also significantly decreased than preoperation (P < 0.01). IOP of 1 to 5 years postoperation dropped significantly from that of preoperation (P < 0.01). Complete success (CS) rate of phaco-trab-5-Fu was 84.2%, 62.7%, 55.3% for 1, 3, 5 years, respectively. There were neither significant difference found in PACG group and POAG group, or in single-incision and separate-incision of CS rate. But mean IOP of last follow-up was significantly different between PACG and POAG [mean IOP (13.8 +/- 4.6) mmHg, (16.2 +/- 3.7) mmHg, respectively, P = 0.02]. According to LogMAR chart, mean preoperative visual acuity (VA) and postoperative VA were 0.75 +/- 0.40 and 0.46 +/- 0.46, respectively. Postoperative VA was significantly improved (P < 0.01). In visual field, MD were (-16.6 +/- 8.8) dB and (-17.6 +/- 10.1) dB at preoperation and postoperation, respectively. PSD were (6.2 +/- 2.9) dB and (6.5 +/- 3.2) dB correspondingly. There were no significant difference in both MD and PSD (P = 0.55, 0.64, respectively). One patient had early endophthalmitis and required vitrectomy. Two late-onset of hypotony were due to choroidal effusion and wound leak.


CONCLUSIONS
Phacoemulsification combined with trabeculectomy and 5-Fu could be a successful and safe treatment for patients with cataract and primary glaucoma in a long run. There is no difference in success rate in PACG and POAG, or in single incision or separate incision in such combined surgery.
Cai
Yu
Y
Peking University first hospital, Beijing 100034, China. cai_yuu@hotmail.com
Lim
Zena
Z
Lim
Boon Ang
BA
Oen
Francis
F
Yan
Xiao-ming
XM
Li
Mei-yu
MY
Seah
Steve
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002386:Cataract / Q000150:complications / Q000628:therapy*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000627:therapeutic use*; D005500:Follow-Up Studies; D005901:Glaucoma / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018918:Phacoemulsification / Q000379:methods*; D012189:Retrospective Studies; D014130:Trabeculectomy / Q000379:methods*; D016896:Treatment Outcome; D014792:Visual Acuity; D014794:Visual Fields
D005472:Fluorouracil