title: Phacoemulsification versus trabeculectomy in medically uncontrolled chronic angle-closure glaucoma without cataract.
abstract: OBJECTIVE
  To compare phacoemulsification versus trabeculectomy with adjunctive mitomycin C in medically uncontrolled chronic angle-closure glaucoma (CACG) without cataract.
  
  
  METHODS
  Prospective, randomized clinical trial.
  
  
  METHODS
  Fifty medically uncontrolled CACG eyes without cataract of 50 patients.
  
  
  METHODS
  Patients were randomized into undergoing either phacoemulsification or trabeculectomy with adjunctive mitomycin C. After surgery, patients were followed up every 3 months for 2 years.
  
  
  METHODS
  Intraocular pressure (IOP) and requirement for glaucoma drugs.
  
  
  RESULTS
  Twenty-six CACG eyes were randomized to receive phacoemulsification, and 24 eyes underwent trabeculectomy with mitomycin C. Phacoemulsification and trabeculectomy resulted in significant and comparable IOP reduction at 24 months after surgery (reduction of 8.4 mmHg or 34% for phacoemulsification vs. 8.9 mmHg or 36% for trabeculectomy; P=0.76). Over first 24 months, trabeculectomy-treated eyes required on average 1.1 fewer drugs than phacoemulsification-treated eyes (P<0.001). However, trabeculectomy was associated with significantly more surgical complications than phacoemulsification (46% vs. 4%; P=0.001). Eight (33%) of 24 trabeculectomy eyes demonstrated cataract during follow-up.
  
  
  CONCLUSIONS
  Both phacoemulsification and trabeculectomy are effective in reducing IOP in medically uncontrolled CACG eyes without cataract. Trabeculectomy is more effective than phacoemulsification in reducing dependence on glaucoma drugs, but is associated with more complications.
  
  
  BACKGROUND
  The author(s) have no proprietary or commercial interest in any materials discussed in this article.
authors.affiliation: Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Kowloon, Hong Kong SAR, People's Republic of China. clemtham@cuhk.edu.hk
authors.forename: Clement C Y
authors.initials: CC
authors.lastname: Tham
authors.forename: Yolanda Y Y
authors.initials: YY
authors.lastname: Kwong
authors.forename: Nafees
authors.initials: N
authors.lastname: Baig
authors.forename: Dexter Y L
authors.initials: DY
authors.lastname: Leung
authors.forename: Felix C H
authors.initials: FC
authors.lastname: Li
authors.forename: Dennis S C
authors.initials: DS
authors.lastname: Lam
mesh_terms: D000328:Adult; 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; D015812:Glaucoma, Angle-Closure / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D018918:Phacoemulsification / Q000379:methods*; D011446:Prospective Studies; D014130:Trabeculectomy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000477:Alkylating Agents; D000959:Antihypertensive Agents; D016685:Mitomycin