Sequential versus Combined Glaucoma and Cataract Procedures in Siriraj Hospital

Objective: To compare the efficacy of intraocular pressure (IOP) control after combined cataract and trabeculectomy with sequential cataract surgery after trabeculectomy, both with and without antimetabolites. Methods: The retrospective study recruited 96 eyes of 73 patients who underwent cataract and glaucoma surgery, and were classified into two groups. Group I sequential procedures: 72 eyes of 56 patients who had undergone a previous trabeculectomy (with or without antimetabolites) for at least 6 months before planned phacoemulsification or ECCE. Groups II combined procedures: 24 eyes of 17 patients who underwent combined trabeculectomy (with or without antimetabolites) with phacoemulsification or ECCE between January 1998 and May 2003. The effects on IOP, best corrected visual acuity, and number of glaucoma medications taken were compared. Results: Mean postoperative IOP without oral medications was 14.17 mmHg in group I and 17.15 mmHg in group II (p=0.05) at 12 month follow up. The mean IOP remained significantly lower in group I (13.67) than in group II (16.36) (p=0.023) at the last follow up. There was a significant difference in surgical success between the groups (p=0.005). The reduction in the mean number of glaucoma medications was significantly higher in group I (p=0.04). In group I the mean IOP before and after cataract surgery were similar (p=0.787) but the numbers of glaucoma medications used were significantly increased (p=0.000) after cataract surgery. Conclusion: Sequential glaucoma and cataract procedure was associated with better IOP control than combined procedure. Cataract surgery in eyes with functioning bleb might have the adverse effect on IOP control