Outcomes of Phaco-trabeculectomy versus Phaco-viscocanalostomy for Primary Open Angle Glaucoma
Amin Zand1 *, Mahdi Sharifzadeh Kermani1 , Maryam Abbasi Moghaddam1 , Mahla Shadravan1 , Ali Sharifi1 , Arash Daneshtalab1
- Department of Ophthalmology, Shafa Hospital, Kerman University of Medical Sciences, Kerman, Iran
Abstract: This study aimed to compare the intraocular pressure (IOP)-lowering effect and postoperative adverse effects of combined phacoemulsification and trabeculectomy (PT) and combined phacoemulsification and viscocanalostomy (PVC) in eyes with primary open-angle glaucoma (POAG).
Methods: In this prospective study, eighty-one consecutive patients (81 eyes) with POAG and cataract were enrolled. The eyes were randomly assigned to either the PT (40 eyes) or the PVC (41 eyes) group. The main outcomes included the success rate based on IOP and the evaluation of adverse effects during the 6-month follow-up period. The surgery was considered a complete success if the IOP was between 6-20 mmHg and reduced by ≥ 30% without anti-glaucoma medications or additional surgery compared to the preoperative level. A qualified success was defined as an IOP between 6-20 mmHg with anti-glaucoma agents or an IOP reduction of < 30% compared to the preoperative level.
Results: The mean baseline IOP was 23.20 ± 7.94 mmHg in the PT group and 21.29 ± 6.81 mmHg in the PVC group (P = 0.249). At 6 months, the mean postoperative IOP in the PT and PVC groups were 13.50 ± 2.49, and 13.73 ± 1.70, respectively. There was no significant difference in the mean IOP between the groups at any time (all Ps > 0.05). At 6 months, 22 patients (55%) in the PT group and 22 patients (53.66%) in the PVC group achieved complete success (P = 1.000). Other patients (45% in the PT group and 46.34% in the PVC group) achieved qualified success (P = 0.904). Intraoperative microperforation of Descemet's membrane occurred in 2 cases (15%) in the PVC group. Postoperative complications included 4 cases (10%) of shallow/flat anterior chamber, 1 case (2.5%) of choroidal effusion, and 1 case (2.5%) of aqueous misdirection in the PT group. The rate of these postoperative adverse effects was not significant between the two groups (all Ps > 0.05).
Conclusion: There was no significant difference in IOP reduction between PT and PVC in patients with POAG. Furthermore, PVC is safe enough in these patients, compared to PT.
