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Phacoemulsification versus trabeculectomy in medically uncontrolled chronic angle-closure glaucoma without cataract.
Clement C Y Tham1, Yolanda Y Y Kwong, Nafees Baig
1Department of Ophthalmology & Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Kowloon, Hong Kong SAR, People's Republic of China. clemtham@cuhk.edu.hk
Ophthalmology
|September 19, 2012
Summary
Phacoemulsification and trabeculectomy effectively lower intraocular pressure in chronic angle-closure glaucoma. Trabeculectomy reduces medication needs more but has higher complication rates.
Area of Science:
- Ophthalmology
- Glaucoma Research
Background:
- Medically uncontrolled chronic angle-closure glaucoma (CACG) without cataract presents a treatment challenge.
- Surgical interventions are considered when medical management fails.
Purpose of the Study:
- To compare the efficacy and safety of phacoemulsification versus trabeculectomy with mitomycin C in patients with medically uncontrolled CACG without cataract.
- To evaluate the impact on intraocular pressure (IOP) and medication requirements.
Main Methods:
- A prospective, randomized clinical trial involving 50 patients with medically uncontrolled CACG.
- Participants were randomized to undergo either phacoemulsification or trabeculectomy with mitomycin C.
- Follow-up occurred every 3 months for 2 years, monitoring IOP and drug usage.
Main Results:
- Both phacoemulsification and trabeculectomy achieved significant and comparable IOP reduction at 24 months (34% vs. 36%).
- Trabeculectomy required significantly fewer glaucoma medications (1.1 fewer on average) compared to phacoemulsification (P<0.001).
- Trabeculectomy had a higher rate of surgical complications (46% vs. 4%, P=0.001) and a 33% incidence of cataract development during follow-up.
Conclusions:
- Phacoemulsification and trabeculectomy are effective IOP-lowering surgical options for medically uncontrolled CACG without cataract.
- Trabeculectomy offers greater reduction in medication dependence but carries a higher risk of complications and cataract formation.
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