Comparison of combined phacoemulsification-non-penetrating deep sclerectomy and phacoemulsification-trabeculectomy

AIM: To compare the outcomes of combined phacoemulsification and non-penetrating deep sclerectomy(P-DS)with combined phacoemulsification and trabeculectomy(P-T)in patients who have cataract and moderate-to-severe primary open angle glaucoma(POAG)or pseudoexfoliative glaucoma(PXG).<p>METHODS: In this prospective randomized study 40 eyes of 40 patients with cataract and POAG or PXG were evaluated. Complete eye examination and glaucoma tests were performed in all patients. Combined P-DS and P-T were performed under local anesthesia in 20 eyes in each group. Visual acuity(VA), intraocular pressure(IOP)and number of glaucoma medications were all recorded preoperatively and postoperative on 10d, 1, 3, 6 and 12mo. Complications, laser goniopuncture in P-DS group and needling in P-T group were also recorded.<p>RESULTS: The age(P-DS, 66.3±11.0 and P-T, 70.2±9.3y)and sex distribution(P-DS, 7 female and 13 male, P-T, 9 female and 11 male)were similar in both groups(<i>P</i>>0.05). Number of POAG and PXG patients were 12 and 8, and 13 and 7 in P-DS and P-T groups, respectively(<i>P</i>>0.05). There was no difference between groups in terms of preoperative VA(P-DS, 0.69±0.22 and P-T, 0.76±0.22 logMAR), IOP(P-DS, 17.9±1.6 and P-T, 18.1±1.9 mm Hg)and number of medications(P-DS: 2.7±0.7 and P-T: 2.9±0.8),(<i>P</i>>0.05). VA increased, IOP and number of medications decreased in both groups postoperatively(<i>P</i><0.01). Postoperative IOPs were 15.0±1.7 and 14.5±1.6 mm Hg in P-DS and P-T groups respectively(<i>P</i>=0.472). Postoperative number of medications were slightly better in P-T group(0.5±0.7)than in P-DS group(0.8±0.9)(<i>P</i>=0.307). There were no complications in both groups. Laser goniopuncture was applied in 7 eyes(once in 5 eyes and twice in 2 eyes)in P-DS group. Needling was performed in 1 eye in P-T group. <p>CONCLUSION: In patients with coexisting cataract and glaucoma, both combined P-DS and P-T may be performed safely. Reliability and efficacy were similar in both groups. Follow-up of P-DS should be done cautiously and when necessary laser goniopuncture should be performed