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Phaco-microtrabeculectomy: technique and intraocular pressure control in comparison with microtrabeculectomy

Alan P Rotchford1, Stephen A Vernon

  • 1Department of Ophthalmology, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK. rotchford@doctors.org.uk

Clinical & Experimental Ophthalmology
|January 5, 2008
PubMed
Abstract

Insights

Combined cataract and glaucoma surgery using phaco-emulsification with micro-trabeculectomy (PMT) offers effective intraocular pressure (IOP) control, comparable to micro-trabeculectomy (MT) alone, with good visual acuity outcomes.

Area of Science:

  • Ophthalmology
  • Surgical Innovation
  • Glaucoma Management

Background:

  • Cataract and glaucoma often coexist, necessitating combined surgical approaches.
  • Traditional combined surgeries may have limitations in intraocular pressure (IOP) control.
  • Micro-trabeculectomy (MT) is a standard procedure for glaucoma, but its combination with cataract surgery requires evaluation.

Purpose of the Study:

  • To introduce and describe a modified technique for combined cataract and glaucoma surgery: phaco-emulsification with micro-trabeculectomy (PMT).
  • To compare the efficacy of PMT in achieving intraocular pressure (IOP) control against micro-trabeculectomy (MT) alone.
  • To assess visual acuity outcomes following the PMT procedure.

Main Methods:

  • A retrospective controlled case series involving 74 low-risk patients.
  • 37 patients underwent PMT with 5-fluorouracil (5-FU) augmentation.
  • 37 patients underwent MT with 5-FU augmentation.
  • IOP control was evaluated using survival analysis with targets of ≤21 mmHg and ≤16 mmHg, and a ≥25% reduction from baseline.

Main Results:

  • After a mean follow-up of approximately 42 months, 91.9% of PMT patients achieved IOP ≤21 mmHg (70.3% without drops).
  • 67.6% of PMT patients achieved IOP ≤16 mmHg (56.8% without drops).
  • No significant difference in IOP control survival rates was observed between PMT and MT groups.
  • Visual acuity improved in 81.1% of PMT patients, with only one eye experiencing worsening vision.

Conclusions:

  • Combined phaco-emulsification with micro-trabeculectomy (PMT) provides IOP control comparable to micro-trabeculectomy (MT) alone.
  • The PMT technique is effective in managing both cataract and glaucoma simultaneously.
  • PMT demonstrates favorable visual acuity outcomes and reduces the need for glaucoma medications.

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