title: Phacoemulsification versus combined phacotrabeculectomy in medically uncontrolled chronic angle closure glaucoma with cataracts.
abstract: OBJECTIVE
  To compare phacoemulsification alone versus combined phacotrabeculectomy in medically uncontrolled chronic angle closure glaucoma (CACG) with coexisting cataract.
  
  
  METHODS
  Prospective randomized clinical trial.
  
  
  METHODS
  Fifty-one medically uncontrolled CACG eyes with coexisting cataract of 51 patients.
  
  
  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
  Twenty-seven CACG eyes were randomized into group 1, and 24 CACG eyes were randomized into group 2. Combined phacotrabeculectomy resulted in lower mean postoperative IOP than phacoemulsification alone at 3 months (14.0 vs. 17.0 mmHg, P = 0.01), 15 months (13.2 vs. 15.4 mmHg, P = 0.02), and 18 months (13.6 vs. 15.9 mmHg, P = 0.01). Combined phacotrabeculectomy resulted in 1.25 fewer topical glaucoma drugs (P<0.001) in the 24-month postoperative period, compared with phacoemulsification alone. Combined surgery was associated with more postoperative complications (P<0.001) and more progression of optic neuropathy (P = 0.03), compared with phacoemulsification alone.
  
  
  CONCLUSIONS
  Combined phacotrabeculectomy with adjunctive mitomycin C is more effective than phacoemulsification alone in controlling IOP in medically uncontrolled CACG eyes with coexisting cataract. Combined phacotrabeculectomy is associated with more postoperative complications.
authors.affiliation: Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China. clemtham@hkstar.com
authors.forename: Clement C Y
authors.initials: CC
authors.lastname: Tham
authors.forename: Yolanda Y Y
authors.initials: YY
authors.lastname: Kwong
authors.forename: Dexter Y L
authors.initials: DY
authors.lastname: Leung
authors.forename: S W
authors.initials: SW
authors.lastname: Lam
authors.forename: Felix C H
authors.initials: FC
authors.lastname: Li
authors.forename: Thomas Y H
authors.initials: TY
authors.lastname: Chiu
authors.forename: Jonathan C H
authors.initials: JC
authors.lastname: Chan
authors.forename: Dennis S C
authors.initials: DS
authors.lastname: Lam
authors.forename: Jimmy S M
authors.initials: JS
authors.lastname: Lai
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000477:Alkylating Agents / Q000008:administration & dosage; D000959:Antihypertensive Agents / Q000008:administration & dosage; 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 / Q000502:physiology; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D018918:Phacoemulsification / Q000379:methods*; D011183:Postoperative Complications; D011446:Prospective Studies; D014065:Tonometry, Ocular; D014130:Trabeculectomy / Q000379:methods*; D016896:Treatment Outcome; D014792:Visual Acuity / Q000502:physiology
chemical_list: D000477:Alkylating Agents; D000959:Antihypertensive Agents; D016685:Mitomycin