Combined phaco-trabeculectomy with implantation of foldable posterior chamber lens implantation. Complications and long-term results

Background. Glaucoma patients who need filtering surgery very often have cataracts as well. Combined glaucoma/cataract surgery entails a higher rate of complications and may endanger the results of glaucoma surgery. Patients and methods. This retrospective study investigated 223 eyes in 169 patients with uncontrolled glaucoma and cataracts. Each eye received filtering surgery and simultaneous phacoemulsification with implantation of a foldable posterior chamber lens. Mean follow-up was 32.5 months (6-57). Results. Mean intraocular pressure was lowered from 24.6+/-6.2 to 16.4+/-3.4 mmHg (P>0.0001). Visual acuity improved from 0.25 (0.01-0.5) to 0.5 (0.01-1.0). Preoperatively the mean number of medications was 2.4 (1-6) and postoperatively 1.3 (1 or 2). The most common perioperative complications were choroidal detachment (20.2%) and fibrin reaction in 10.1%; those occurring later than 4 weeks postoperatively were posterior capsule opacification requiring YAG laser capsulotomy (11.5%) and scarring of filtering bleb (7.7%). Conclusion. Complications encountered in the combined procedure were due mainly due to cataract surgery of glaucomatous eyes with narrow pupils and posterior synechiae. A shallow anterior chamber occurred in only one case. Despite complications the success rate in lowering intraocular pressure was comparable to that observed in filtering surgery alone.