Outcomes of combined cataract extraction, lens implantation, and trabeculectomy surgeries

PURPOSE: To report outcomes and their association with preoperative and int raoperative factors of 456 combined cataract and glaucoma operations. METHODS: A concurrent series (from January 1, 1987, to October 1, 1997) of one surgeon's consecutive 585 (456 patients) combined cataract extraction, intraocular lens implantation, and trabeculectomy surgeries, some with intr aoperative mitomycin C and/or postoperative subconjunctival 5-fluorouracil. The study was a retrospective outcomes analysis for the first 191 operatio ns (before June 10, 1992) and, subsequently, concurrent outcomes analysis f or the latter 394 operations. Main outcome measures included postoperative visual acuity, intraocular pressure, number of glaucoma medications, intrao perative and postoperative adverse event rates, and reoperation for glaucom a or other ocular surgical or laser intervention. RESULTS: Visual acuity was improved at the time of last follow-up in 402 (8 8.2%) of 456 first operated eyes of the 456 patients. Increasing age (coeff icient = 0.025; CI [confidence interval], 0.017 to 0.33; P < .0001) was ass ociated with a decreased likelihood of improved visual acuity, and a more r ecent operation (coefficient 0.0037; 95% CI, -0.0064 to -0.0010, P = .0082) was associated with an increased Likelihood of improved visual acuity. For ty-one (9.0%) of 456 eyes had reoperation to control intraocular pressure. Glaucoma reoperation was most strongly associated with a preoperative diagn osis other than primary open-angle, pigmentary, or pseudoexfaliative glauco ma, a history of previous ocular surgery, and high preoperative intraocular pressure. Mean intraocular pressure reduced 5.5 mm Hg from 21.8 mm Hg preo peratively to 16.3 mm Hg postoperatively and mean glaucoma medication from 2.0 to 0.9 medications. Mitomycin C or 5-fluorouracil use was significantly associated with a lower postoperative intraocular pressure and reduced pos toperative glaucoma medication. Major postoperative adverse event or other reoperation (not for glaucoma) occurred in 12 (2.6%) of first operated eyes . CONCLUSIONS: Combined surgery outcomes in 456 first operated eyes of 456 pa tients showed 88.2% improved visual acuity, 9% re-operation rate, 5.5 mm Hg mean intraocular pressure reduction, 1.1 glaucoma medication reduction, an d a low major postoperative adverse event rate, Type of glaucoma, previous ocular surgery, and high preoperative intraocular pressure were the best pr edictors for the need for reoperation for glaucoma after combined surgery. Mitomycin C and/or 5-fluorouracil provided a greater reduction of mean intr aocular pressure and glaucoma medication compared with patients not receivi ng these agents. (C) 2000 by Elsevier Science Inc. All rights reserved.