Combined phacoemulsification-viscosynechialysis-trabeculotomy vs phacotrabeculectomy in uncontrolled primary angle-closure glaucoma with cataract

Purpose: To compare the effect on intraocular pressure (IOP) of phacoemulsification combined with viscosynechialysis and trabeculotomy with that of phacoemulsification combined with trabeculectomy in eyes with primary angle-closure glaucoma (PACG) and visually significant cataract. Setting: Mansoura Ophthalmic Center, Mansoura University, Egypt. Design: Prospective case series. Methods: This prospective randomized study included patients with uncontrolled PACG and visually significant cataract presenting between 2012 and 2017. The eyes were randomized to phacoemulsification combined with viscosynechialysis and trabeculotomy (phaco-viscosynechialysis group) or phacoemulsification combined with trabeculectomy (phacotrabeculectomy group). Success (true and qualified) (IOP <18 mm Hg without sight-threatening complications) was studied 24 months postoperatively. Intraoperative complications were noted. The primary outcome measure was the IOP before and after surgery. Results: The study comprised 59 eyes of 59 patients with a mean age of 59.8 years 6.8 (SD) in the phaco-viscosynechialysis group (30 eyes) and 60.3 +/- 6.3 years in the phacotrabeculectomy group (29 eyes) (P = .704). The mean preoperative IOP was 28.7 +/- 2.14 mm Hg in the phaco-viscosynechialysis group and 28.5 +/- 2.11 mm Hg in the phacotrabeculectomy group; the mean at 24 months was 14.5 +/- 2.8 mm Hg and 17.3 +/- 2.2 mm Hg, respectively (P <.001). The total success rate at 24 months was 90% and 83%, respectively. Conclusion: Although both techniques were relatively safe and effective in reducing IOP for at least 2 years in eyes with PACG, combined phacoemulsification-viscosynechialysis-trabeculotomy gave better outcomes. (C) 2019 ASCRS and ESCRS.