Phacoemulsification Versus Combined Phacotrabeculectomy in Medically Controlled Chronic Angle Closure Glaucoma with Cataract
Presented in part at: American Academy of Ophthalmology Annual Meeting, November 2007, New Orleans, Louisiana, as Poster (Poster 81).
Received 3 December 2007; received in revised form 11 June 2008; accepted 11 June 2008. published online 18 September 2008.
Objective
To compare phacoemulsification alone versus combined phacotrabeculectomy in medically controlled chronic angle closure glaucoma (CACG) with coexisting cataract.
Design
Randomized clinical trial.
Participants
Seventy-two medically controlled CACG eyes with coexisting cataract.
Intervention
Recruited patients were randomized into group 1 (phacoemulsification alone) or group 2 (combined phacotrabeculectomy with adjunctive mitomycin C). Postoperatively, patients were reviewed every 3 months for 2 years.
Main Outcome Measures
Intraocular pressure (IOP) and requirement for topical glaucoma drugs.
Results
Thirty-five CACG eyes were randomized into group 1, and 37 CACG eyes were randomized into group 2. There were no statistically significant differences (P>0.05) in mean IOP between the 2 treatment groups preoperatively and postoperatively, except at 1 month (P = 0.001) and 3 months (P = 0.008). Combined phacotrabeculectomy with adjunctive mitomycin C resulted in 0.80 less topical glaucoma drugs (P<0.001) in the 24-month postoperative period compared with phacoemulsification alone. The differences in IOP control were, however, not associated with differences in glaucomatous progression. Combined surgery was associated with more postoperative (P<0.001) complications compared with phacoemulsification alone.
Conclusions
Combined phacotrabeculectomy with adjunctive mitomycin C may be marginally more effective than phacoemulsification alone in controlling IOP in medically controlled CACG eyes with coexisting cataract. Combined surgery may be associated with more complications and additional surgery in the postoperative period. Further study is needed to determine whether the marginally better IOP control of combined surgery justifies the potential additional risks of complications and further surgery.
Financial Disclosure(s)
The authors have no proprietary or commercial interest in any materials discussed in this article.
Available online: September 18, 2008.
1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, People's Republic of China
2Hong Kong Eye Hospital, Kowloon, Hong Kong SAR, People's Republic of China
3Prince of Wales Hospital, Shatin, N. T., Hong Kong SAR, People's Republic of China
4Department of Ophthalmology, United Christian Hospital, Kowloon, Hong Kong SAR, People's Republic of China
5Caritas Medical Centre, Kowloon, Hong Kong SAR, People's Republic of China
Correspondence: Clement C. Y. Tham, FRCS, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, 147K Argyle Street, Kowloon, Hong Kong
Manuscript no. 2007-1547.
Financial Disclosure(s): No conflicting relationship exists for any author.
Financial support: Direct Grant for Research from the Chinese University of Hong Kong 2004–2005. The funding organization had no role in the design or conduct of this research.
ABSTRACT