Phacoemulsification versus combined phacotrabeculectomy in medically controlled chronic angle closure glaucoma with cataract.
OBJECTIVE
To compare phacoemulsification alone versus combined phacotrabeculectomy in medically controlled chronic angle closure glaucoma (CACG) with coexisting cataract.


METHODS
Randomized clinical trial.


METHODS
Seventy-two medically controlled CACG eyes with coexisting cataract.


METHODS
Recruited patients were randomized into group 1 (phacoemulsification alone) or group 2 (combined phacotrabeculectomy with adjunctive mitomycin C). Postoperatively, patients were reviewed every 3 months for 2 years.


METHODS
Intraocular pressure (IOP) and requirement for topical glaucoma drugs.


RESULTS
Thirty-five CACG eyes were randomized into group 1, and 37 CACG eyes were randomized into group 2. There were no statistically significant differences (P>0.05) in mean IOP between the 2 treatment groups preoperatively and postoperatively, except at 1 month (P = 0.001) and 3 months (P = 0.008). Combined phacotrabeculectomy with adjunctive mitomycin C resulted in 0.80 less topical glaucoma drugs (P<0.001) in the 24-month postoperative period compared with phacoemulsification alone. The differences in IOP control were, however, not associated with differences in glaucomatous progression. Combined surgery was associated with more postoperative (P<0.001) complications compared with phacoemulsification alone.


CONCLUSIONS
Combined phacotrabeculectomy with adjunctive mitomycin C may be marginally more effective than phacoemulsification alone in controlling IOP in medically controlled CACG eyes with coexisting cataract. Combined surgery may be associated with more complications and additional surgery in the postoperative period. Further study is needed to determine whether the marginally better IOP control of combined surgery justifies the potential additional risks of complications and further surgery.


BACKGROUND
The authors have no proprietary or commercial interest in any materials discussed in this article.
Tham
Clement C Y
CC
Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China. clemtham@hkstar.com
Kwong
Yolanda Y Y
YY
Leung
Dexter Y L
DY
Lam
S W
SW
Li
Felix C H
FC
Chiu
Thomas Y H
TY
Chan
Jonathan C H
JC
Chan
Catherine H Y
CH
Poon
Agnes S Y
AS
Yick
Doris W F
DW
Chi
C C
CC
Lam
Dennis S C
DS
Lai
Jimmy S M
JS
D000368:Aged; D000369:Aged, 80 and over; D000477:Alkylating Agents / Q000008:administration & dosage; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002386:Cataract / Q000150:complications*; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D015812:Glaucoma, Angle-Closure / Q000150:complications* / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D018918:Phacoemulsification / Q000379:methods*; D011183:Postoperative Complications; D014065:Tonometry, Ocular; D014130:Trabeculectomy / Q000379:methods*; D016896:Treatment Outcome
D000477:Alkylating Agents; D000959:Antihypertensive Agents; D016685:Mitomycin