Pm. Munden et Wlm. Alward, COMBINED PHACOEMULSIFICATION, POSTERIOR CHAMBER INTRAOCULAR-LENS IMPLANTATION, AND TRABECULECTOMY WITH MITOMYCIN-C, American journal of ophthalmology, 119(1), 1995, pp. 20-29
PURPOSE: We evaluated the effectiveness of combined phacoemulsificatio
n, posterior chamber intraocular lens implantation, and trabeculectomy
with mitomycin C in patients with coexisting cataract and glaucoma. M
ETHODS: We conducted a retrospective review of the records of 21 conse
cutive patients who had combined phacoemulsification, posterior chambe
r intraocular lens implantation, and trabeculectomy with mitomycin C.
Patients were selected for the combined procedure on the basis of the
degree to which intraocular pressure was controlled, toleration of med
ical therapy, degree of glaucomatous optic nerve damage, and extent of
visual impairment because of cataract. Nine (43%) of the 21 patients
had previous incisional surgery and were at high risk of surgical fail
ure. All patients had at least six months' follow-up. Sixteen (76%) of
21 patients had at least one year of follow up. RESULTS: The mean pre
operative intraocular pressure was 20.8 +/- 5.0 mm Hg (range, 13 to 35
mm Hg), which decreased to a mean postoperative intraocular pressure
of 15.1 +/- 3.1 mm Hg (range, 9 to 21 mm Hg) as measured at last follo
w up (P = .0002). The intraocular pressure was controlled between 6 an
d 21 mm Hg) in all patients at last follow up. Seventeen (81%) of 21 p
atients had a best corrected visual acuity of 20/40 or better at last
follow-up. No patient had a decrease in visual acuity after surgery. F
ifteen (71%) of 21 patients were using no antiglaucoma medications at
last follow-up. Four of the remaining six patients were using one medi
cation, and two were using two medications. A hyphema (less than 1.0 m
m) was seen in seven (33%) of 21 patients and was the most common post
operative complication. No patient had a postoperative wound or bleb l
eak or a shallow anterior chamber. No patient developed symptomatic hy
potony, CONCLUSIONS: The glaucoma triple procedure with adjunctive mit
omycin C appears to be a safe and effective surgical technique for tre
ating selected patients with coexisting cataract and glaucoma.