Comparison of outcomes following combined ECCE-trabeculectomy versus phacoemulsification-trabeculectomy

To analyze and compare the main outcomes between trabeculectomies combined with extracapsular cataract extraction (ECCE) versus those with phacoemulsification (Phaco).

The authors retrospectively reviewed one surgeon's 357 consecutive cases (475 eyes) of combined cataract extraction, intraocular lens implantation and Mitomycin enhanced trabeculectomy. Patients were divided into two groups, those who underwent extracapsular cataract extraction (80 eyes) and those having phacoemulsification (395 eyes). Analysis of postoperative visual acuity, intraocular pressure (IOP), number of glaucoma medications, postoperative adverse events and additional procedures required, was done. Minimum follow-up was 12 months with an average of 53 months.

There was no significant difference (p = 1.000) between the groups in terms of visual acuity improvement rate, 66% (ECCE) versus 59% (Phaco). Postoperatively IOP with both techniques fell significantly (p < 0.0001). Earlier IOP reduction was obtained with Phacoemulsification, but there was no difference by the end of the follow up period (14.4 mmHg ECCE vs. 14.1 mmHg Phaco, p = 1.0000). Postoperative pressure spikes occurred in 6% versus 10% (p = 0.3995) of the eyes. No significant difference (55% ECCE versus 63% Phaco, p = 0.1674) between the two groups in terms of glaucoma medication reduction was found. The total number of postoperative complications (89% versus 68.5%) were significantly higher (p = 0.0001) in the ECCE-group, as well as the total number of eyes which required further interventions (86% versus 64%, p = 0.0001).

Both combined surgery techniques are effective and yielded similar long-term results. However phacoemulsification can decrease the post operative complications associated with this surgery.