Combined trabeculectomy and cataract extraction versus trabeculectomy alone in primary angle-closure glaucoma.

Abstract

To compare the long-term efficacy and safety of combined trabeculectomy and cataract extraction versus trabeculectomy alone in primary angle-closure glaucoma (PACG). Hospital files were retrospectively examined for 99 Chinese PACG patients; 75 patients underwent combined surgery and 24 underwent trabeculectomy alone. Success rates were assessed with the Kaplan-Meier survival analysis. The main outcome was the complete success rate defined as either a >20% reduction in intraocular pressure (IOP) or an IOP that remained below 15 mm Hg, with no medications required. Patients in the combined group and trabeculectomy group had a mean follow-up period of 25.8 (SD 10.8) months and 31.4 (8.9) months, respectively. Survival analysis showed that the complete success rate at 3 years was 56% in the combined group and 54% in the trabeculectomy group (p = 0.903). There were no significant differences between groups in either IOP or the number of glaucoma medications throughout the 3-year follow-up. The incidences of postoperative complications were similar between groups (p = 0.232). No additional IOP-lowering surgical procedures were required in the combined group, while 13 (54%) eyes in the trabeculectomy group required either cataract extraction or further IOP-lowering surgical procedures (p <0.001). In patients with PACG, the long-term IOP-lowering effect and surgical complications of combined trabeculectomy and cataract extraction are comparable with those of trabeculectomy alone. However, the combined surgery incurred fewer subsequent surgical interventions.