Success rates of 2-site phacoemulsification combined with fornix-based trabeculectomy using mitomycin C for primary angle-closure glaucoma and primary open-angle glaucoma in an Asian population

Purpose To determine the long-term outcomes of 2-site phacoemulsification combined with fornix-based trabeculectomy using mitomycin C (MMC) for primary angle-closure glaucoma (PACG) and primary open-angle glaucoma (POAG) in an Asian population. Methods We reviewed the records of all patients with POAG or PACG who underwent phacoemulsification with trabeculectomy using MMC from January 2008 through December 2010 in a tertiary ophthalmology unit in Singapore. The primary outcome measure was cumulative success rates defined as complete [intraocular pressure (IOP) < 21, 18, 15 mmHg without medication] and qualified (IOP < 21, 18, 15 mmHg with at least 1 medication) success. Results In total, 168 eyes (110 POAG and 58 PACG) were included (43.5% female; mean age +/- SD, 68.3 +/- 8.2 years). The respective 3-year qualified success rates were 88.4, 79.3, and 52.5% for IOP < 21, 18, and 15 mmHg. The corresponding complete success rates were 79.0, 70.9, and 51.1%. The mean 3-year postoperative IOP was 14.5 +/- 4.4 mmHg, and the IOP reduction was significantly greater for PACG than for POAG eyes (P = 0.006). After surgery, the mean number of medications was significantly reduced and visual acuity, significantly improved (both P < 0.001). Occurrence of postoperative complications, higher number of topical medications, younger age, and presence of diabetes mellitus were significant risk factors for surgical failure. Conclusion Two-site phacoemulsification combined with fornix-based trabeculectomy using MMC is a good surgical approach for Asian eyes with concomitant mild-to-moderate primary glaucoma and cataracts.