Comparison of 2 Surgical Techniques in Phacotrabeculectomy: 1 Site versus 2 Sites

Abstract

Purpose.

To compare 1-site and 2-site phacotrabeculectomies with regard to visual acuity, intraocular pressure (IOP) control, antiglaucoma medication requirements, and postoperative complications.

Methods.

In a randomized controlled trial, 169 eyes with coexisting visually significant cataract and glaucoma were randomly allocated into 2 groups: eyes that had a trabeculectomy in a superior quadrant combined with phacoemulsification through the same incision (1-site group; n=85) or those with a separate, temporal, clear corneal incision for phacoemulsification (2-site group; n=84). Postoperative evaluation, including visual acuity, intraocular pressure (IOP), glaucoma medication requirements, and surgical complications, was for up to 18 months.

Results.

After 18 months, there was no significant difference between the 2 groups with respect to visual acuity and antiglaucoma medication requirements. There was a 0.6 to 1.4 mmHg difference in mean IOP, with the 2-site technique demonstrating statistically significant advantage over the 1-site technique in some follow-up visits with nonparametric analysis; however, the difference cannot be clinically significant. Success rates (IOP<21 mmHg with the maximum use of medication) of 1-site and 2-site groups were 85.9% and 92.8%, respectively, which was not statistically significant (p=0.153). Nevertheless, the incidence of failure in the 1-site group was almost twice that of the 2-site group (12 vs 6). Postoperative complications were comparable in both groups.

Conclusions.

Results for 18-month follow-ups of 1-site and 2-site phacotrabeculectomies were comparable in terms of visual acuity, antiglaucoma medication requirements, and postoperative complications. While lowering of IOP was more pronounced in the 2-site group, this was not clinically significant.