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Combined phacoemulsification and trabeculectomy with mitomycin-C
J M Ruderman1, B Fundingsland, M A Meyer
1Department of Ophthalmology, North-western University Medical School, Chicago, Illinois 60611-1210, USA.
Journal of Cataract and Refractive Surgery
|October 1, 1996
Summary
Combined phacoemulsification, intraocular lens implantation, and trabeculectomy with mitomycin-C safely reduced intraocular pressure and improved vision in glaucoma patients. Mitomycin-C did not appear to significantly enhance outcomes in this combined procedure.
Area of Science:
- Ophthalmology
- Glaucoma Research
- Surgical Innovation
Background:
- Cataracts and open-angle glaucoma often coexist, necessitating combined surgical approaches.
- Effective intraocular pressure (IOP) management is crucial for preventing glaucoma progression.
- Phacoemulsification with intraocular lens (IOL) implantation is a standard cataract surgery technique.
Purpose of the Study:
- To evaluate the safety and efficacy of primary combined phacoemulsification, posterior chamber IOL implantation, and trabeculectomy with mitomycin-C.
- To assess visual acuity outcomes and IOP control in patients with open-angle glaucoma and cataracts.
- To identify potential complications associated with this combined surgical procedure.
Main Methods:
- Retrospective analysis of 43 consecutive patients undergoing combined surgery by a single surgeon.
- Inclusion of patients with open-angle or pseudoexfoliative glaucoma and visually significant cataracts.
- Follow-up duration of at least 6 months, with 88% of patients observed for 12 months.
Main Results:
- Mean preoperative IOP of 21.6 mm Hg decreased to 14.2 mm Hg at last follow-up, with a reduction in glaucoma medications.
- 55% of patients achieved an IOP of 15 mm Hg or less at 12 months.
- Good visual acuity (20/40 or better) was achieved in 72% of patients; however, complications such as IOP spikes, hyphema, and wound leaks were observed.
Conclusions:
- Combined phacoemulsification, IOL implantation, and trabeculectomy with mitomycin-C can yield good visual acuity and effective IOP control.
- The addition of mitomycin-C to this combined procedure did not demonstrate a significant additional benefit.
- While effective, the procedure is associated with a notable rate of complications requiring careful patient monitoring.