title: Long-term efficacy of combined phacoemulsification plus trabeculectomy versus phacoemulsification plus excimer laser trabeculotomy.
abstract: BackgroundCombined cataract and glaucoma procedures, and minimally-invasive glaucoma surgery in particular, have gained increasing interest over the past few years. The aim of this study was to compare the long-term efficacy of combined phaco-trabeculectomy (Phaco-Trab) and combined phacoemulsification plus excimer laser trabeculotomy (Phaco-ELT).Patients and MethodsRetrospective, non-randomised, comparative, interventional case series of consecutive patients after Phaco-Trab and Phaco-ELT at the University Hospital of Zurich and the Talacker Eye Center Zurich in Switzerland. Inclusion criteria were diagnosis of glaucoma plus vision-impairing coexisting cataract. Primary outcome measures were change in intraocular pressure (IOP), number of anti-glaucoma drugs (AGDs), and best-corrected visual acuity (BCVA) 1 year and 4 years after the procedure. Secondary outcome measures were surgical complications and requirement of postoperative interventions. Success was defined based on the criteria of the Tube-versus-Trabeculectomy study.ResultsMean age was 76.1 ± 8.6 years (29.2 % males; 47.8 % right eyes). Phaco-Trab (n = 62) decreased median IOP from 22.8 to 13.0 at 1 year and to 14.0 mmHg at 4 years. AGDs were reduced from 2 drugs to 0 AGDs at 1 year and 4 years. Median BCVA improved from 0.2 logMAR to 0.0 logMAR at 1 year and 4 years. Phaco-ELT (n = 51) lowered median IOP from 19.0 to 15.0 at 1 year and to 14.0 mmHg (p = 0.002) at 4 years. AGDs were reduced from 2 drugs to 1 AGD at 1 year and 4 years (p = 0.002). BCVA improved from 0.4 logMAR to 0.1 logMAR after 1 year and 4 years. If not stated otherwise, all changes compared to baseline were highly significant (p < 0.001). No perioperative complications occurred; postoperative interventions were performed in 74 % of Phaco-Trab patients.ConclusionBoth surgical procedures reduced IOP and AGDs and improved BCVA significantly and persistently during the entire follow-up period of 4 years with a good safety profile. This study validates Phaco-ELT as an option when post-operative target pressure in the mid-teens would be adequate, whereas Phaco-Trab would be the treatment of choice when IOP in the low teens is desired.
authors.affiliation: UniversityHospital Zurich, Department of Ophthalmology, Zurich, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Töteberg-Harms
authors.affiliation: UniversityHospital Zurich, Department of Ophthalmology, Zurich, Switzerland.
authors.forename: J
authors.initials: J
authors.lastname: Wachtl
authors.affiliation: Augenklinik, Klinikum Chemnitz.
authors.forename: C
authors.initials: C
authors.lastname: Schweier
authors.affiliation: UniversityHospital Zurich, Department of Ophthalmology, Zurich, Switzerland.
authors.forename: J
authors.initials: J
authors.lastname: Funk
authors.affiliation: UniversityHospital Zurich, Department of Ophthalmology, Zurich, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Kniestedt
mesh_terms: D000368:Aged; D002386:Cataract / Q000175:diagnosis / Q000453:epidemiology*; D003131:Combined Modality Therapy / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D005901:Glaucoma / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D054018:Lasers, Excimer / Q000706:statistics & numerical data* / Q000627:therapeutic use*; D008137:Longitudinal Studies; D008297:Male; D018918:Phacoemulsification / Q000379:methods / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D015995:Prevalence; D012307:Risk Factors; D013557:Switzerland / Q000453:epidemiology; D014130:Trabeculectomy / Q000379:methods / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014792:Visual Acuity