TRABECULOTOMY COMBINED WITH PHACOEMULSIFICATION AND IMPLANTATION OF AN INTRAOCULAR-LENS FOR THE TREATMENT OF PRIMARY OPEN-ANGLE GLAUCOMA AND COEXISTING CATARACT

BACKGROUND AND OBJECTIVE: The authors previously reported the usefulne ss of trabeculotomy ab externo for the treatment of primary open-angle glaucoma in adult patients. In an attempt to elucidate the long-term risk-to-benefit ratio of this surgical modality in combination with ca taract surgery, the authors conducted a retrospective study of the sur gical effects and complications of a triple procedure: phacoemulsifica tion, implantation (of an intraocular lens), and trabeculotomy (PIT). PATIENTS AND METHODS: The authors conducted a retrospective study of p atients treated with PIT at multiple hospitals. Intraocular pressure ( IOP) and visual function data were obtained from patients after PIT as an initial surgical treatment in cases where antiglaucoma medications failed to resolve uncontrolled IOP (higher than 21 mm Hg). Included i n this study were 96 eyes of 64 patients with primary open-angle glauc oma and coexisting cataract. The mean follow-up period was 22.6 +/- 14 .7 months (range 3-56 months). RESULTS: In 94 (98%) of the 96 eyes, th e IOP was well controlled, having achieved a level of 21 mm Hg or lowe r at the final examinations. The mean preoperative IOP of the 33 eyes that underwent the triple procedure using a single flap method (PIT-I) was 24.3 +/- 3.9 mm Hg, with an average of 2.1 +/- 1.1 medications. A t the final examinations, the mean IOP had dropped to 16.0 +/- 1.2 mm Hg, with an average of 1.2 +/- 1.2 medications. The mean preoperative IOP of-the 63 eyes that underwent the triple procedure using a double flap method (PIT-II) was 26.2 +/- 6.2 mm Hg, with an average of 1.9 +/ - 1.2 medications. At the final examination, the mean IOP for this gro up was 15.6 +/- 2.9 mm Hg, with an average of 1.0 +/- 0.9 medications. CONCLUSION: The long-term results from this multicenter study showed that the triple procedure, PIT, can be useful and effective as an init ial surgical treatment for open-angle glaucoma in glaucoma patients wi th coexisting cataract.