A Study on Long Term Control of Intraocular Pressure in Patients undergoing Small Incision Cataract Surgery with Trabeculectomy

INTRODUCTION: In patients with visually significant cataract and glaucoma, a combined technique of cataract extraction with trabeculectomy is considered as a standard surgical procedure. AIM OF THE STUDY: To study the long term control of intraocular pressure and bleb morphology in patients undergoing combined Small incision cataract surgery and trabeculectomy. MATERIAL AND METHODS: 83 eyes of 75 patients with both glaucoma and cataract were operated for SICS with trabeculectomy. A detailed history, preoperative and postoperative evaluation including visual acuity, slit lamp examination, applanation tonometry, gonioscopy, automated perimetry and fundus examination was done. Patients were followed up till one year. RESULTS: In the study 60% had POAG, 30% PACG, 7% SOAG, 3% had SACG. 78% had severe glaucomatous damage. Early postoperative IOP of > 10mmHg on day 5 or 13mmHg on 10th postoperative day was associated with poor IOP control at 1 year. P value 0.003 and 0.0005 respectively. Vascularisation was a risk factor for both flat bleb and poor control of postoperative IOP with a P value of 0.0001, and 0.012 at 1 year. Complete success rate of procedure was 60.5%, and qualified success rate was 96%. CONCLUSION: Success rate in PACG was higher than POAG. Early high postoperative IOP was a risk factor for poor control of intraocular pressure at the end of 1 year. Vascularisation of bleb was found to be a risk factor for flat bleb.