COMBINED TRABECULECTOMY AND PHACOEMULSIFICATION - A ONE-SITE VS A 2-SITE APPROACH

PURPOSE: To compare the results of combined trabeculectomy and phacoem ulsification surgery with intraocular lens implant by means of a one s ite vs a two site approach. METHODS: Glaucomatous patients with a coex isting cataract were randomly assigned to undergo either a one-site or two site combined procedure. One-site surgery was performed with a li mbus based conjunctival flap and scleral tunnel at the 12 o'clock posi tion. Two-site surgery was per formed with a limbus based conjunctival flap for the trabeculectomy in the superior nasal quadrant and a temp oral clear cornea incision for phacoemulsification. Mitomycin C (0.4 m g/ml for 2 minutes) was applied to the scleral surface at the trabecul ectomy site for both approaches. All patients received intraocular len s implants at the time of combined surgery. RESULTS: Thirty three eyes of 33 patients were included in this study. Preoperative intraocular pressure and number of glaucoma medications were similar in the two gr oups. Corrected visual acuity improved similarly in both groups. Intra ocular pressure decreased in both groups at last follow up but was not significantly different (P = .129) between the one-site and two site groups. At last follow-up, the one site group required significantly m ore (P = .030) medications than did the two-site group. CONCLUSIONS: C ombined trabeculectomy and phacoemulsification surgery in which one si te and two-site techniques were used yielded similar improvements in c orrected visual acuity and intraocular pressure reduction. However, th e one-site group required more medication to maintain intraocular pres sure control than did the two site group. (C) 1998 by Elsevier Science Inc. All rights reserved.