Long-term results of combined 1-way phacoemulsification, intraocular lens implantation, and trabeculectomy

Purpose: To analyze the results of 1-way phacoemulsification and posterior chamber intraocular lens (IOL) implantation combined with trabeculectomy. Setting: Department of Ophthalmology and Neurosurgery, University of Siena, Siena, Italy. Methods: This retrospective study comprised 42 eyes of 36 patients with gla ucoma and cataract who had phacoemulsification with posterior chamber IOL i mplantation combined with trabeculectomy. The mean follow-up of 28.24 month s +/- 10.99 (SD) (range 11 to 52 months) included measurement of intraocula r pressure (IOP), visual acuity, visual field, endothelial cell loss, and n otation of complications. Results: There was a statistically significant postoperative improvement in visual acuity (P < .001). Mean preoperative best corrected visual acuity ( BCVA) was 20/200 (range 20/30 to hand movements). Mean 1 year postoperative BCVA was 20/30 (range 20/20 to 20/60). The preoperative mean IOP of 24.06 mm Hg decreased to 15.36 mm Hg at 1 year (P < .001). All 42 eyes hd a posto perative IOP of less than 21.00 mm Hg. Mean central cornea endothelial cell density preoperatively was 2238 +/- 396 cells/mm(2) (range 1697 to 2906 ce lls/mm(2)) and postoperatively, 2005 +/- 397 cells/mm(2) (range 1302 to 280 1 cells/mm(2)). Early postoperative complications consisted of a choroidal detachment in 2 patients (4.76%). Three and 4 days after surgery, respectiv ely, 2 patients (4.76%) had surgery to remove viscoelastic substance under th IOL. Late complications included posterior synechias in 3 eyes (7.14%). One year after surgery, because of a significant decrease in vision, a neod ymium:YAG laser posterior capsulotomy was necessary in 2 eyes, 1 with an ac rylic IOL (3.70%) and 1 with a silicone lens (9.09%). Conclusion: Combined phacoemulsification, posterior chamber IOL implantatio n, and trabeculectomy was safe and effective in patients with coexisting gl aucoma and cataract. J Cataract Refract Surg 1999; 25:1641-1645 (C) 1999 AS CRS and ESCRS.