LONG-TERM RESULTS OF COMBINED TRABECULECTOMY AND SMALL-INCISION CATARACT-SURGERY

We did a prospective study of 49 eyes (36 patients) with coexisting ca taract and glaucoma who had combined trabeculectomy, phacoemulsificati on, and implantation of a folded polyHema intraocular lens through the trabeculectomy opening. Preoperatively, intraocular pressure (IOP) wa s controlled (< 20 mm Hg) in 13 eyes on a mean of 2.2 medications and uncontrolled (> 20 mm Hg) in 36 eyes on a mean of 2.4 medications. Pre operative visual acuity ranged from 20/40 to hand movements. At the en d of the follow-up, IOP was below 18 mm Hg in all eyes (100%), without therapy in 39 (80%) and with reduced therapy in 8 (16%). Two (4%) eye s were controlled on the same medication regimen. Visual acuity improv ed in 42 patients (86%); 38 (78%) achieved a visual acuity of 20/40 or better. A filtering bleb was observed in 45 eyes (92%). The most comm on early postoperative complication was fibrin exudation into the ante rior chamber. Late complications included posterior synechias and visi on-impairing capsule opacifications. Visual acuity improved after neod ymium:YAG laser treatment in all eyes with opacification without furth er complications. We conclude that the combination of small incision c ataract surgery and trabeculectomy is a successful surgical approach f or long-term visual rehabilitation and glaucoma control.