Phacotrabeculectomy for glaucoma with cataract

Objective To evaluate the therapeutic effects、safety and surgical improvements of phacotrabeculectomy and intraocular lens implantation by the same surgeon. Methods In this retrospective study,53 eyes of 47 patients with glaucoma and cataract accepted phacotrabeculectomy and intraocular lens implantation between Jan 2003 and Oct 2006 in our hospital.Pre-and post-operation intraocular pressure(IOP)、glaucoma medications、bestspectacle-corrected visual acuity(BSCVA) and visual field、postoperative complications were analyzed.All cases were followed up for 12~18 months,the average is 16.7months.Surgical improvements include:(1)use of MMC and 5-FU;(2)2-site Phacotrabeculectomy;(3)adjustable suture;(4) fornix-based flap. ResultsOver a mean 16.7month follow-up,49 of the 53 eyes(92.45%) achieved intraocular pressure(IOP) control(21 mm Hg) with or without medication.28 eyes(52.83%) had an IOP of 15 mm Hg or lower.The IOP decreased from a preoperative mean of(25.17±3.70) mmHg on a mean number of(1.89±0.49) glaucoma medications to a mean of(16.79±2.78) mmHg at the final follow-up for IOP decrease and only 8 eyes(15.09%) left using 1 kind of glaucoma medication.There was statistically significant difference between Pre-and post-operation IOP(t = 21.60,P0.000).39eyes(73.58%) obtained a best spectacle-corrected visual acuity of 0.5 or better.The improvement in BSCVA was statistically significant difference at final visits compared with the preoperative level(z =-5.845,P0.001).Post-operation 2 eyes(3.77%) shallow anterior chamber,3eyes(5.66%) cystoid macular edema,leye(1.89%) choroidal detachment. Conclusions Phacotrabeculectomy is effective at restoring visual acuity, lowering IOP,reducing glaucoma medication and reduce the postoperative complication rate.Surgical improvements increase the safety and efficacy of Phacotrabeculectomy.