Effect of phacoemulsification on trabeculectomy function

Background: To evaluate the effect of phacoemulsification on trabeculectomy function. Design: Retrospective case-control study. Participants: Forty-eight patients who underwent trabeculectomy surgery and had at least 2 years of follow up. Methods: Patients were classified into two groups: patients who had phacoemulsification subsequent to trabeculectomy (Trab_phaco, n = 18) and patients who were pseudophakic for greater than 6 months preceding their trabeculectomy (Phaco_trab, n = 30). Groups were matched for length of follow up of 2 years from time of trabeculectomy. Main Outcome Measures: The primary outcome measures were target intraocular pressure of criteria A, <= 12 mmHg; B, <= 15 mmHg; C, <= 18 mmHg with or without additional topical treatment. A separate measure for bleb function failure was also used; with failure defined as the need for additional topical antiglaucoma therapy or surgical intervention to achieve control of intraocular pressure. Results: There was no significant difference in achieving each intraocular pressure criterion between groups (12 months, P = 1.0; 24 months, P = 0.330). In the first 12 months, significantly more trabeculectomies in the Trab_phaco group failed, requiring additional intervention to control the IOP (39%) compared with the Phaco_trab (10%) group (P = 0.028). Although this trend continued at 24 months, there were no significant differences in failure rates (P = 0.522). Conclusions: Phacoemulsification performed after trabeculectomy significantly increased rates of bleb failure in the following 12 months but not at 24 months.