Comparison of surgical results of trabeculectomy and phaco-trabeculectomy in Chinese glaucoma patients

Abstract

Purpose: To compare the surgical results of trabeculectomy and phaco-trabeculectomy in Chinese glaucoma patients. Methods: Retrospective case series of 38 patients who underwent trabeculectomy or combined phacoemulsification with trabeculectomy. Post-operative visual acuity (VA), intra-ocular pressure (IOP), bleb morphology and complications were compared. Post-operative data at 1 day, 1 week, 1 month and 3 months were analysed. Results: Among the 38 eyes, 20 eyes received phaco-trabeculectomy and 18 eyes received trabeculectomy. The 2 groups had no significant baseline differences in age, VA, IOP, cup-disc ratio and number of glaucoma mediations used. IOP on post-operative 1 day (p = 0.26), 1 week (p = 0.89), 1 month (p = 0.74) and 3 months (p = 0.99) did not show significant difference between 2 groups. Complete success was achieved in 65% of phaco-trabeculectomy, and 66.7% of trabeculectomy cases. Qualified success was achieved in 20% of phacotrabeculectomy, and 16.7% of trabeculectomy cases. There was 10% failure rate in phaco-trabeculectomy group, and 16.7% of trabeculectomy cases at 3 months. VA on day 1 (p = 0.58), 1 week (p = 0.66), 1 month (p = 0.59) and 3 months (p = 0.84) were not significantly different between 2 groups. The percentage of patients with reduction in VA were similar throughout, except at 3 months, 30% of phaco-trabeculectomy group sustained worse VA, but present in 55.6% of trabeculectomy patients. Phaco-trabeculectomy group consistently showed better post-operative VA compared to pre-operatively then trabeculectomy group. On day 1, 25% of phacotrabeculectomy patients had VA improvement, compared to 16.7% in trabeculectomy group. At 1 week and 1 month, 45% of phaco-trabeculectomy group had better VA, but 0% in trabeculectomy patients. At 3 months, 50% of phaco-trabeculectomy cases had improved VA, compared to 11% of trabeculectomy patients. Diffuse bleb was identified in 40% of phaco-trabeculectomy and 72% of trabeculectomy eyes; while flat blebs were found in 30% of phaco-trabeculectomy, and none in the trabeculectomy group. Complications were rare. The only complication was hypotony, which occurred in 6% of phaco-trabeculectomy, and 0.06% in trabeculectomy. Conclusions: Phaco-trabeculectomy and trabeculectomy demonstrated comparable IOP control up to 3 months post-operatively. However, phaco-trabeculectomy patients did better in VA improvement. Nonetheless, patients receiving trabeculectomy alone had more diffuse bleb and less hypotony.