The risk profile of trabecular aspiration versus trabeculectomy in glaucoma triple procedure.

OBJECTIVE

This study was set up to establish the relative safety and effectiveness of trabecular aspiration in combination with phacoemulsification and intraocular lens (IOL) implantation (phacoaspiration) for decreasing intraocular pressure (IOP), and to compare the outcome of this method of treatment with that of standard filtering glaucoma triple procedure (phaco-trab).

STUDY DESIGN

Prospective, randomized study.

PARTICIPANTS

The study consisted of 40 eyes of 40 patients with uncontrolled exfoliation glaucoma without a history of previous intra- or extraocular surgery and in need of cataract surgery.

INTERVENTION

Temporal clear corneal phacoemulsification and foldable IOL implantation was performed in all eyes. In the phaco-aspiration group, trabecular aspiration was performed with a suction force of 100-200 mmHg under light tissue-instrument contact using a modified intraocular aspiration probe. A modified Cairns-type trabeculectomy without adjunctive antimetabolites was performed superiorly in the phaco-trab eyes after IOL implantation.

MAIN OUTCOME MEASURES

The surgical outcome was assessed in terms of IOP change, need for adjunctive glaucoma medication, visual acuity outcome, and incidence of complications.

RESULTS

At 1 year after combined surgery, mean (+/-SD) IOP and number of glaucoma medi- cation were 19.5+/-2.7 mmHg and 0.6+/-0.5 in the phaco-aspiration group, compared with 17.5+/-2.4 mmHg and 0.3+/-0.4 in the phaco-trab group. Hyphema (38%) and ocular hypotony (14%) were observed in the phaco-trab group only, whereas blood reflux (52%) and descemetolyses (23%) were seen exclusively in the phaco-aspiration group.

CONCLUSION

In exfoliative eyes, trabecular aspiration in combination with phacoemulsification and IOL implantation is less effective in reducing postoperative IOP and number of glaucoma medications than the standard filtering glaucoma triple procedure. The risk profile, however, appears to be more favorable in the phaco-aspiration-treated eyes than in the phaco-trab group. Trabecular aspiration in glaucoma triple procedure could serve as a possible treatment of choice for exfoliative eyes with coexisting cataract and glaucoma.