Combined cataract extraction and trabeculectomy: phacoemulsification compared with extracapsular technique

Thirty-four eyes undergoing phacoemulsification and trabeculectomy (PHACO + TRAB) were followed prospectively for 1 year postoperatively. The results of surgery were compared with those, obtained retrospectively, of the previous 34 extracapsular cataract extractions with trabeculectomy (ECCE + TRAB) performed by the same surgical team. All eyes received posterior chamber intraocular lens implants. Preoperatively, the two groups did not differ significantly in terms of age, gender distribution, or degree and duration of glaucoma and cataract. Mean postoperative follow up for the ECCE+TRAB group was 13.6 months; for the PHACO + TRAB group, 12.6 months (P = .1). As compared with the ECCE + TRAB group, the PHACO + TRAB group had earlier visual rehabilitation, less postoperative astigmatism (P < .001), and improved long-term intraocular pressure control (P = .04). Early postoperative pressure spikes occurred in 32% of the ECCE + TRAB eyes and in 23.5% of the PHACO + TRAB eyes (P = .2). Other postoperative complications occurred more commonly in the ECCE + TRAB group: hyphema (P < .001), fibrinous iritis (P < .01), choroidal detachment (P < .05), and hypotony (P < .05). Posterior capsular opacification was significantly more common in the ECCE + TRAB group (P < .02). These major differences probably are attributable primarily to the small incision used in phacoemulsification, which is associated with sustained IOP control during the operation, a small stable wound with low postoperative astigmatism, and early stabilization of refraction.