Comparison between phaco-deep sclerectomy and phaco-deep sclerectomy reconverted into phaco-trabeculectomy: series of fellow eyes

To evaluate and compare the results and complications after uneventful phaco-deep sclerectomy in one eye with intended phaco-deep sclerectomy converted to phaco-trabeculectomy in the fellow eye. In this retrospective study, we analyzed thirty-two eyes of sixteen patients in which bilateral phaco-deep sclerectomy was planned but one eye was converted to phaco-trabeculectomy after perforation of the trabeculo-Descemet's membrane. Visual acuity (VA), slit-lamp examinations, intraocular pressure (IOP), and the number of glaucoma medications were recorded preoperatively and postoperatively at 1 day, 1 week, and 1, 3, 6, 12, 18, and 24 months. The postoperative complications were recorded. Comparisons between the two groups were performed. The IOP was significantly lower in both groups at every postoperative visit. The postoperative IOP and VA levels did not differ significantly between the groups. However, at the last postoperative visit, eyes that underwent uneventful phaco-deep sclerectomy required fewer glaucoma medications than eyes converted to phaco-trabeculectomy (P = 0.04). At 24 months, the group that underwent uneventful phaco-deep sclerectomy had a higher complete success rate (P = 0.01). Immediate postoperative complications such as hyphema, a shallow anterior chamber, or a choroidal detachment occurred more frequently in eyes converted to phaco-trabeculectomy, although the difference did not reach significance. There were no differences in VA or IOP control between uneventful phaco-deep sclerectomy and phaco-deep sclerectomy converted to phaco-trabeculectomy. However, fewer drugs were needed to successfully control IOP and the rate of complications was lower if phaco-deep sclerectomy was completed uneventfully.