Results of combined phacoemulsification and trabeculectomy through scleral tunnel incision and goniotrephination alone

Purpose We retrospectively evaluated the results of combined phacoemulsification and trabeculectomy through scleral tunnel incision in comparison with those of goniotrephination alone. Patients and methods 27 eyes of 20 patients (78.3 +/- 7.45 years) underwent a combined trabeculectomy and phacoemulsification with IOL-implantation (PT-group). The traberulectomy was performed by excision of 2 mm middle part of the lower tunnel lip. In comparison with the TP-group 29 eyes of 28 patients (69.3 +/- 8.1 years) underwent a goniotrephination (Fronimopoulos), (G-group). The median of follow up was 8 weeks. Results In both groups a significant reduction of the IOP was achieved; in the PT-group the IOP was reduced from 31,0 +/- 5,42 to 15,0 +/- 4.5 mmHg, in the G-group from 31.4 +/- 6.3 to 11.6 +/- 4.12 mmHg. In the PT-group the visual acuity increased significantly from 0.25 +/- 0.14 to 0.37 +/- 0.27 and decreased significantly from 0.46 +/- 0.28 to 0.32 +/- 0.25 in the G-group. 3 patients (=11%) needed topical medication in the PT-group and 6 (=24%) in the G-group. Four patients (=15%) of the PT-group underwent a secondary surgery and 7 (=24%) of the G-group. Conclusions The combined phacoemulsification and trabeculectomy is a successful method of IOP control and visual rehabilitation. Due to the decrease of visual acuity and a higher frequency of secondary surgery after goniotrephination alone the combined procedure should be preferred even in presence of a moderately visual acuity reducing cataract.