Uneventful Phacoemulsification after Trabeculectomy in Pseudoexfoliation Glaucoma versus Primary Open-Angle Glaucoma

Area of Science:

• Ophthalmology
• Glaucoma Research
• Surgical Outcomes

Background:

• Conflicting results exist regarding phacoemulsification efficacy in filtered eyes with open-angle glaucoma.
• This study compares phacoemulsification outcomes after trabeculectomy in pseudoexfoliation glaucoma (XFG) versus primary open-angle glaucoma (POAG).

Purpose of the Study:

• To compare the effects of phacoemulsification combined with trabeculectomy versus trabeculectomy alone.
• To evaluate intraocular pressure (IOP) control, medication requirements, and success rates in XFG and POAG patients.

Main Methods:

• Retrospective review of consecutive patients undergoing phacoemulsification after trabeculectomy (TRAB-PHACO group) or trabeculectomy only (TRAB group).
• Matched comparison of IOP, medication use, and surgical success rates.
• Survival analysis using Kaplan-Meier and multivariate logistic regression to identify factors influencing success.

Main Results:

• Phacoemulsification in XFG eyes showed a delayed but statistically significant IOP increase at 24 months compared to baseline.
• Glaucoma medication increase was significant at the last visit for XFG and at 6 months for POAG in the TRAB-PHACO group.
• Trabeculectomy failure was more common in XFG than POAG in the TRAB group (p=0.02); IOP spike >25 mmHg in the first 24h post-op was linked to failure (p=0.04).

Conclusions:

• Uneventful phacoemulsification in filtered XFG eyes may delay time-related worsening of IOP control.
• Phacoemulsification after trabeculectomy may reduce the need for additional glaucoma surgery in XFG patients.