Phacotrabeculectomy: peripheral iridectomy or no peripheral iridectomy?

Area of Science:

• Ophthalmology
• Surgical Innovation

Background:

• Glaucoma and cataracts frequently coexist, requiring combined surgical intervention.
• Phacotrabeculectomy is a standard procedure for managing combined cataract and glaucoma.
• The role of peripheral iridectomy (PI) in phacotrabeculectomy is debated.

Purpose of the Study:

• To evaluate the impact of peripheral iridectomy (PI) on outcomes following phacotrabeculectomy.
• To compare intraocular pressure (IOP), bleb development, visual acuity, and complications between phacotrabeculectomy with and without PI.

Main Methods:

• Retrospective analysis of 126 eyes from 117 patients undergoing phacotrabeculectomy.
• Patients were randomized to receive either peripheral iridectomy (PI) or no PI.
• Key postoperative parameters including IOP, bleb formation, visual acuity, and complications were assessed over 12 months.

Main Results:

• No statistically significant differences were observed in visual acuity or intraocular pressure (IOP) between the PI and no-PI groups.
• The group without PI required significantly more 5-fluorouracil therapy for bleb development compared to the PI group.
• Bleb failure rates and the need for laser suture lysis were not significantly different between the two groups. Complications were infrequent in both groups.

Conclusions:

• Phacotrabeculectomy performed without a peripheral iridectomy (PI) appears to be a viable alternative for managing patients with concurrent cataracts and glaucoma.
• The addition of PI may reduce the need for adjunctive therapies for bleb management, though overall efficacy and safety remain comparable.