Long-term results of combined trabeculectomy and small incision cataract surgery

We did a prospective study of 49 eyes (36 patients) with coexisting cataract and glaucoma who had combined trabeculectomy, phacoemulsification, and implantation of a folded polyHema intraocular lens through the trabeculectomy opening. Preoperatively, intraocular pressure (IOP) was controlled (< 20 mm Hg) in 13 eyes on a mean of 2.2 medications and uncontrolled (> 20 mm Hg) in 36 eyes on a mean of 2.4 medications. Preoperative visual acuity ranged from 20/40 to hand movements. At the end of the follow-up, IOP was below 18 mm Hg in all eyes (100%), without therapy in 39 (80%) and with reduced therapy in 8 (16%). Two (4%) eyes were controlled on the same medication regimen. Visual acuity improved in 42 patients (86%); 38 (78%) achieved a visual acuity of 20/40 or better. A filtering bleb was observed in 45 eyes (92%). The most common early postoperative complication was fibrin exudation into the anterior chamber. Late complications included posterior synechias and vision-impairing capsule opacifications. Visual acuity improved after neodymium:YAG laser treatment in all eyes with opacification without further complications. We conclude that the combination of small incision cataract surgery and trabeculectomy is a successful surgical approach for long-term visual rehabilitation and glaucoma control.