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

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.