Long-Term Efficacy of Phacoemulsification Combined With Trabeculectomy for Advanced Chronic Primary Angle-Closure...

To evaluate the long-term efficacy of phacoemulsification combined with trabeculectomy (Phaco-Trab) for advanced chronic primary angle-closure glaucoma (PACG) with cataract.

Patients with advanced chronic PACG coexisting with cataracts who underwent Phaco-Trab were enrolled. The morphologic structures of filtering blebs, including characteristics under slit-lamp examination, anterior segment optical coherence tomography (AS-OCT), and in vivo confocal microscopy (IVCM), were used to evaluate the filtering function.

A total of 30 eyes from 27 patients were enrolled. The mean preoperative intraocular pressure (IOP) of 19.98 ± 6.48 mmHg significantly decreased to 13.73 ± 2.35 mmHg at year 3 (p < 0.0001). A statistically significant decrease in postoperative IOP-lowering medications was observed, but the number of drugs used increased annually (0.50 ± 0.82 at year 1, 1.00 ± 0.98 at year 2, and 1.47 ± 0.97 at year 3, p < 0.0001). Following Phaco-Trab, a high surgical qualified success rate was maintained over 3 years (93.3% at year 1, 90.0% at year 2, and 80.0% at year 3, p = 0.117). However, the complete success rate significantly decreased each year (70.0% at year 1, 36.7% at year 2, and 20.0% at year 3, p < 0.0001), along with an increase in the rate of failure filtering blebs, reaching 46.7%, 83.3%, and 90.0% at each time point (p < 0.0001). Overall, 46.7% (14/30) of participants developed complications and required postoperative procedures after Phaco-Trab, which were mainly induced by the trabeculectomy procedure.

Phaco-Trab can significantly lower IOP and reduce the use of IOP-lowering medications for advanced chronic PACG with cataracts, but it is associated with a higher rate of complications and a higher failure rate of the filtering bleb.