Combined versus sequential phacotrabeculectomy with intraoperative 5-fluorouracil

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Cataract Surgery

Background:

• Glaucoma and cataracts often coexist, requiring surgical intervention.
• Phacoemulsification is standard for cataract removal.
• Trabeculectomy is a common glaucoma surgery to lower intraocular pressure (IOP).

Purpose of the Study:

• To compare the IOP-lowering efficacy of single-incision combined phacoemulsification and trabeculectomy versus phacoemulsification after prior trabeculectomy.
• Both surgical approaches utilized an intraoperative dose of 5-fluorouracil (5-FU).

Main Methods:

• Retrospective analysis of 18 eyes (Group 1) undergoing phacoemulsification after previous trabeculectomy with intraoperative 5-FU.
• Comparison with 22 matched eyes (Group 2) undergoing combined phacoemulsification and trabeculectomy with intraoperative 5-FU.
• Postoperative IOP and survival curves (IOP < 20 mm Hg and IOP ≤ 15 mm Hg) were analyzed using paired Student t test and log-rank analysis.

Main Results:

• Mean postoperative IOP was similar between groups (12.6 mm Hg in Group 1 vs. 12.2 mm Hg in Group 2; P = .64).
• Group 2 showed a trend towards significant IOP decrease (P = .0575), while Group 1 did not.
• No significant difference in survival curves was observed between groups based on IOP criteria (P = .333 and P = 1.00).

Conclusions:

• Combined cataract and glaucoma surgery with intraoperative 5-FU demonstrates comparable long-term IOP control to repeat glaucoma surgery after phacoemulsification.
• Both surgical strategies effectively manage IOP in patients with coexisting cataracts and glaucoma.