Prospective intrapatient comparison of extracapsular cataract extraction and lens implantation with and without trabeculectomy.

PURPOSE

To determine whether extracapsular cataract extraction and posterior chamber lens implantation combined with trabeculectomy provides better long-term results than extracapsular cataract extraction and lens implantation alone in a group of patients with primary open-angle glaucoma and cataract.

METHODS

In a prospective, randomized clinical trial, 35 patients with bilateral, symmetric, primary open-angle glaucoma and visually disabling cataracts were randomly selected to undergo surgery with trabeculectomy in one eye and without in the other. All procedures were performed by a single surgeon in a private practice setting with follow-up for more than 5 years in all cases.

RESULTS

After an average of 87 months of follow-up, extracapsular cataract extraction and posterior chamber lens implantation reduced intraocular pressure by 4.4 +/- 3.3 mm Hg, reduced the number of medications by 1.28 +/- 0.86, increased diopter vector of astigmatism by 1.49, and was associated with visual field loss in six of 35 eyes. After an average of 80 months of follow-up, extracapsular cataract extraction and posterior chamber lens implantation with trabeculectomy reduced intraocular pressure by 8.2 +/- 4.6 mm Hg (P =.0001), reduced the number of medications by 1.76 +/- 0.82 (P=.0002), increased diopter vector of astigmatism by 1.14, and was associated with visual field loss in one eye (P =.05). Both groups had similar improvement in visual acuity and perioperative complications.

CONCLUSIONS

Extracapsular cataract extraction and posterior chamber lens implantation with trabeculectomy was beneficial in the long-term control of intraocular pressure and in prevention of visual field loss. This procedure should be considered for patients in whom long-term pressure control at a lower level would be beneficial in preventing further optic nerve damage.