COMBINED PHACOEMULSIFICATION, POSTERIOR CHAMBER INTRAOCULAR-LENS IMPLANTATION, AND TRABECULECTOMY WITH MITOMYCIN-C

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.