Cataract extraction and lens implantation with and without trabeculectomy: an intrapatient comparison

To determine whether cataract extraction and lens implantation combined with trabeculectomy provides better long-term results than cataract extraction and lens implantation alone in a group of patients with primary open-angle glaucoma and cataract randomly selected to receive surgery with trabeculectomy in one eye and without in the other.

A prospective, randomized clinical trial involving 35 patients with bilateral symmetric primary open-angle glaucoma and visually disabling cataracts with procedures performed by a single surgeon in a private practice setting with follow-up for more than 5 years in all cases.

After an average of 87 months of follow-up, cataract extraction and lens implantation reduced intraocular pressure 4.4 mm Hg, reduced number of medications by 1.28, increased diopter vector of astigmatism by 1.49, and was associated with visual field loss in 6 of 35 eyes. After an average of 80 months of follow-up, cataract extraction, lens implantation, and trabeculectomy reduced intraocular pressure 8.2 mm Hg, reduced number of medications by 1.76, increased diopter vector of astigmatism by 1.14, and was associated with visual field loss in 1 eye. Both groups had similar improvement in visual acuity and perioperative complications.

Extracapsular cataract extraction, lens implantation, and trabeculectomy is a complex procedure that was beneficial in the long-term control of intraocular pressure and in prevention of visual field loss. This procedure should be considered in patients who may not be able to comply with a complex medical regimen, in whom pressure elevation in the immediate postoperative period would be undesirable, or in whom long-term pressure control at a lower level would be beneficial in preventing further optic nerve damage.