Temporal corneal phacoemulsification combined with superior trabeculectomy. A retrospective case-control study.

OBJECTIVE: To determine the results of temporal corneal phacoemulsification combined with separate-incision superior trabeculectomy plus low-dose 5-fluorouracil compared with trabeculectomy plus low-dose 5-fluorouracil.
DESIGN: Retrospective case-control study. PATIENTS: Forty consecutive case patients who underwent temporal corneal phacoemulsification combined with superior trabeculectomy plus low-dose 5-fluorouracil (case [combined surgery] group) and 40 control patients, matched for age race, preoperative intraocular pressure (IOP), number of preoperative antiglaucoma medications, and number of 5-fluorouracil injections, who underwent trabeculectomy alone plus low-dose 5-fluorouracil (control [trabeculectomy] group). MAIN OUTCOME MEASURES: Survival analyses for IOP control compared between the 2 groups.
METHODS: The medical records of 40 consecutive case patients were reviewed to determine the effect of their treatment on IOP, visual acuity, and requirement for glaucoma medications. In the control group, 40 eyes (1 eye per patient) were randomly selected for comparison with the case group. In both groups, the trabeculectomy was located superiorly and performed with the same technique and using a limbus-based conjunctival flap. In the case group, temporal corneal phacoemulsification immediately preceded trabeculectomy and used a 3.2-mm incision and a 1-piece silicone intraocular lens. All patients received 3 or 4 subconjunctival 5-fluorouracil injections of 5 mg each within the first 11 postoperative days. Patients were followed up for at least 1 year. Success of surgery was defined as an IOP of less than 22 mm Hg and a 20% or more reduction from the preoperative level on 2 consecutive follow-up visits, regardless of the use of antiglaucoma medications.
RESULTS: The mean (+/-SD) postoperative IOP was statistically higher in the case group than in the control group at each follow-up interval (P < .05). The mean (+/-SD) IOP reductions at 1 year were 6.8 +/- 5.5 mm Hg and 10.3 +/- 7.6 mm Hg (39.2% +/- 18.8%) in the case and control groups, respectively (P = .04). The reductions in the mean (+/-SD) number of antiglaucoma medications at 1 year were 1.6 +/- 0.9 and 2.0 +/- 1.0 in the case and control groups, respectively (P = .06). In the case group, the mean visual acuity beyond the first postoperative month was significantly better than at baseline (P < .001). Kaplan-Meier survival analysis showed that the cumulative success rates at 2 years were 62.1% and 85.8% in the case and control groups, respectively. The survival time to failure was significantly shorter (P = .04) in the case group by the log-rank test.
CONCLUSIONS: Combined surgery for cataract and glaucoma is associated with less long-term IOP reduction compared with trabeculectomy alone despite identical trabeculectomy techniques used in both groups. Nevertheless, combined surgery lowers IOP and reduces the long-term requirement for antiglaucoma medications. This technique is appropriate in selected patients with coexisting cataract and glaucoma.