Phaco-microtrabeculectomy: technique and intraocular pressure control in comparison with microtrabeculectomy.
OBJECTIVE
To describe a modified technique for combined cataract and glaucoma drainage surgery involving a small flap (micro) trabeculectomy combined with phaco-emulsification (PMT). To assess the level of intraocular pressure (IOP) control achieved by this procedure in comparison with microtrabeculectomy (MT) alone.


METHODS
In this retrospective controlled case series records were reviewed for 37 consecutive low-risk patients undergoing PMT augmented with 5-fluorouracil (5-FU) and 37 low-risk subjects undergoing MT with 5-FU. IOP control was compared by survival analysis using IOP targets < or = 21 mmHg and < or = 16 mmHg at final follow up and with at least a 25% reduction from the preoperative pressure.


RESULTS
Mean follow up was 41.7 months (range 19.0-72.0) in the PMT group and 43.5 months (range 18.0-66.0) in the MT group. A final IOP < or = 21 mmHg and with at least a 25% reduction from the preoperative pressure was achieved in 91.9% patients undergoing PMT (70.3% on no glaucoma drops). IOP < or = 16 mmHg and with at least a 25% reduction from the preoperative pressure was achieved in 67.6% (56.8% without drops). There were no significant differences in survival rates between PMT and MT for either IOP target. The mean final IOPs were 13.4 and 13.5 mmHg on a mean of 0.6 and 0.8 glaucoma drops in the PMT and MT groups, respectively. In the PMT final visual acuity improved by at least one Snellen line in 81.1% and was worse in a single eye.


CONCLUSIONS
IOP control following combined surgery by PMT is as good as following MT alone.
Rotchford
Alan P
AP
Department of Ophthalmology, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK. rotchford@doctors.org.uk
Vernon
Stephen A
SA
D000368:Aged; D000369:Aged, 80 and over; D002386:Cataract / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D005901:Glaucoma / Q000150:complications* / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008866:Microsurgery / Q000379:methods*; D018918:Phacoemulsification; D012189:Retrospective Studies; D016019:Survival Analysis; D014130:Trabeculectomy / Q000379:methods*; D016896:Treatment Outcome