Abstract:

Objective To observe the safety and efficacy of trabeculotomy combined with phacoemulsification for primary open-angle glaucoma (POAG) with cataract. Design case-controlled study. Participants Thirty-six eyes of 36 POAG patients with cataract underwent surgery in Beijing Tongren Eye Centre from Mar. 2018 to Mar. 2019. Methods According to the surgical method selected by the patients, the patients were divided into two groups: 12 patients (12 eyes) receiving trabeculectomy combined with phacoemulsification were the observation group, and 24 patients (24 eyes) receiving trabeculectomy alone were the control group. The intraocular pressure (IOP), visual acuity, complications and the types of antiglaucoma drugs were recorded and compared between the two groups before surgery and at 1, 2, 3, 5 days, 1 week and 1 month after surgery. Main Outcome Measures IOP, the presenting visual acuity, short-term postoperative complications and antiglaucoma drops. Results The highest preoperative IOP for treatment group and control group were (34.08±8.21) mmHg and (37.75±8.61) mmHg respectively（P=0.46）. Mean IOP decreased postoperatively, being (20.75±11.89) mmHg at 1 day, (21.23±8.72) mmHg at 1 week, and (15.00±2.22) mmHg at 1 months in treatment group, and being (16.08±5.63) mmHg at 1 day, (22.08±11.48) mmHg at 1 week, and (16.05±5.25) mmHg at 1 months in control group. The intraocular pressure decreased with time in the two groups after surgery (all P<0.001). Although postoperative intraocular pressure fluctuations were different between the two groups, there was no statistical significance (P=0.77). The mean amplitude of IOP decrease in the two groups after 1 month were 53.09%±15.19% and 55.68%±15.63% respectively (P=0.64). Mean kind of antiglaucoma drops before surgery was 2.67±0.99 and 3.08±0.72（P=0.16）, and decreased to 0.17±0.58 and 0.96±1.33 in treatment group and control group at 1 months after the surgery (P=0.06). Transient IOP spikes were observed in 16.67% and 54.17% in the treatment group and control group (P=0.03). The most frequent postoperative complication was hyphema, 83.3% in treatment group and 62.5% in control group (P=0.21). Ciliary body detachment was observed in 25.0% in treatment group versus 75.0% in control group (P=0.004). In treatment group, the presenting visual acuity of operated eyes improved in 8 eyes（66.7%), and remained in 4 eyes (33.3%). In control group, the presenting visual acuity of operated eyes remained in 20 eyes (83.3%), and decreased in 4 eyes (16.7%)，the change of visual acuity was different in the two groups (P<0.001). Conclusion Both trabeculotomy combined with phacoemulsification and trabeculotomy alone could reduce IOP effectively for POAG. The incidence of transient IOP spike was lower in trabeculotomy combined with phacoemulsification than trabeculotomy alone. However the middle- and long-term efficacy between the two groups is yet to be determined.

Key words: trabeculotomy, phacoemulsification, primary open-angle glaucoma, intraocular pressure, complications