Combined phacoemulsification and trabeculectomy with mitomycin-C

To evaluate the effectiveness of combined phacoemulsification and trabeculectomy with mitomycin-C with respect to visual rehabilitation and control of intraocular pressure in patients with coexisting cataract and glaucoma.

The authors retrospectively studied 20 consecutive cases of phacoemulsification with posterior chamber intraocular lens implantation combined with trabeculectomy using mitomycin-C. They included in their study 20 eyes of 19 patients with primary open-angle glaucoma, pseudoexfoliation glaucoma, inflammatory glaucoma, chronic angle-closure glaucoma, and normal tension glaucoma.

After a mean postoperative follow-up time of 14.4 +/- 3.1 months, intraocular pressure was reduced from a preoperative mean of 19.2 +/- 6.1 mm Hg to a postoperative mean of 13.4 +/- 3.9 mm Hg (P = .0004). The number of required intraocular pressure-lowering medications dropped from a preoperative mean of 2.3 +/- 0.7 medications to 0.2 +/- 0.4 medications postoperatively (P < .0001), with only 4 eyes requiring the restarting of a single medication each. Mean log10 (minimum angle of resolution) visual acuity improved from a preoperative 0.66 +/- 0.53 (Snellen 20/91) to a postoperative 0.30 +/- 0.40 (Snellen 20/40) (P < .0005). The most frequent complication was a bleb leak (8 of 20 eyes [40%]), usually occurring early and responding to conservative management. One eye with later-onset bleb leak incurred endophthalmitis. In another eye, hypotony with maculopathy developed.

Phacoemulsification combined with trabeculectomy using mitomycin-C appears to be an effective approach to the management of cataract in patients with glaucoma. It offers potential for good improvement in visual acuity as well as long-term control of intraocular pressure with reduced or no dependence on medications. Potential vision-threatening complications of this procedure, specifically hypotony maculopathy and late-onset bleb leaks, should be considered in the decision to use mitomycin-C.