Comparative study between phacoemulsification and combined phacotrabeculectomy in the treatment of medically controlled chronic angle-closure glaucoma with coexistent cataract

Purpose The aim of this study is to compare the efficacy and safety of either phacoemulsification alone or combined phacotrabeculectomy with adjunctive mitomycin-c in the surgical treatment of medically controlled chronic angle-closure glaucoma with coexisting cataract guided by ultrasonic biomicroscopy imaging to evaluate the morphological changes of the anterior chamber (AC). Patients and methods Forty-eight eyes of 38 patients were included in this randomized clinical trial. They were equally divided into group A (phacoemulsification alone) and group B (combined phacotrabeculectomy with mitomycin-c). Ultrasonic biomicroscopy was carried out 1 month postoperatively to measure the mean AC depth, trabecular–iris angle, and angle opening at 500 µm (AO 500). The patients were evaluated up to 24 months postoperatively with documentation of intraocular pressure (IOP), number of IOP-lowering drugs, best corrected visual acuity, gonioscopy, perimetry, complications, additional maneuvers, and any additional surgical intervention. Results Both groups achieved lower mean IOP values, with statistically significantly less use of antiglaucoma drugs. Group B showed a mean of 0.96 mmHg lower IOP, with 0.21 mean decreases of the antiglaucoma drugs, both with no statistical significance in comparison with group A. Both groups showed statistically significant increases in all AC parameters postoperatively. However, only the mean AC depth was statistically significantly higher in group A. Group B was associated with significantly more intraoperative and postoperative complications, as well as additional interventions. Conclusion Phacoemulsification could be recommended as an initial line of treatment for medically controlled chronic angle-closure glaucoma with coexisting cataract guided by AC deepening. Although combined phacotrabeculectomy can achieve relatively better IOP control with less drug dependence, it may be associated with more complications and additional surgical interventions.