Evaluation of Efficacy of Phacotrabeculotomy in Management of Cases With Coexisting Cataract and Glaucoma
Narrative Responses:
Purpose
To evaluate the effectiveness of a combined procedure of modified trabeculotomy, phacoemulsification and intraocular lens implantation in the management of cases with coexisting cataract and late onset developmental glaucoma (LODG)
Methods
This prospective interventional study comprised 20 eyes (12 patients) with coexisting cataract and late-onset developmental glaucoma. A combined procedure of phacoemulsification, intraocular lens implantation and modified trabeculotomy was performed by 1 surgeon. Glaucoma surgery site was at 12 o’clock. 2 Phaco incisions were placed at 2 and 11 o’clock positions. Follow-up visits were made at 1 day, weeks 1, 2, month 1, 2, then bi-monthly till 18.
Results
All eyes showed significant IOP lowering at day 1 (12.2mmHg (SD 5.4)). Peri-operative complications included hyphema in 14 eyes (70%), which resolved within 1 week, and IOP spikes to 21mmHg or more, at weeks 1, 2 in 8 eyes (40%). By month 18, 17 eyes had complete success, (IOP < 21 mmHg without medications), 3 eyes had IOP < 21 mmHg with medications. At 18 months post-surgery, the mean number of medications had fallen from 2.45 (SD 1.2) to 0.25 (SD 0.3) (p < 0.001). Visual acuity improved by a mean value of 1.8 lines (SD 2.0) over baseline (p = 0.016).
Conclusion
Modified phaco-trabeculotomy is an effective option with minimal complications for managing eyes of co-existing cataract and early onset developmental glaucoma