Phacoemulsification vs phacotrabeculectomy in chronic angle-closure glaucoma with cataract complications

Abstract

Objective: To compare the complications of phacoemulsification alone vs combined phacotrabeculectomy in chronic angle-closure glaucoma (CACG) with coexisting cataract. Methods: Patients with CACG with coexisting cataract recruited into 2 randomized controlled trials comparing phacoemulsification alone vs combined phacotrabeculectomy were pooled for analysis. The first trial recruited patients with medically controlled intraocular pressure, while the second trial recruited patients with medically uncontrolled intraocular pressure. The 2 trials had otherwise identical study designs. All patients were reviewed every 3 months for 2 years after surgery. The main outcome measure was the surgical complications of phacoemulsification alone vs combined phacotrabeculectomy in CACG eyes with cataract. Results: One hundred twenty-three CACG eyes with cataract from 123 patients were included. Sixty-two CACG eyes were randomized to receive phacoemulsification alone, and 61 eyes had combined phacotrabeculectomy. In the phacoemulsification group, 5 of the 62 CACG eyes (8.1%) had a total of 5 surgical complications. In the combined phacotrabeculectomy group, 16 of the 61 CACG eyes (26.2%) had a total of 19 surgical complications. The difference in the proportion of eyes with 1 or more surgical complications between the 2 treatment groups was statistically significant (P=.007, Pearson χ2 test). There was no statistically significant difference in final visual acuity or glaucomatous progression during the 24-month follow-up. Conclusions: Combined phacotrabeculectomy resulted in significantly more surgical complications than phacoemulsification alone in CACG eyes with coexisting cataract. There was no difference in visual acuity or disease progression between the 2 treatment groups. ©2010 American Medical Association. All rights reserved.