Phacoemulsification versus Phacotrabeculectomy in Medically Controlled Primary Angle Closure Glaucoma with Cataract in an Indian Cohort: A randomized controlled trial

Abstract

Purpose To compare the outcomes of phacoemulsification with phacotrabeculectomy in primary angle closure glaucoma (PACG) eyes with medically controlled intraocular pressure (IOP). Methods Prospective, randomized control trial including 33 eyes of 33 patients who underwent phacoemulsification (Phaco) and 37 eyes (37 patients) who underwent phacotrabeculectomy (PT). The primary outcome measure was survival defined as IOP control (IOP C 6 and B 21 mmHg without antiglaucoma medications (AGM) at different time points. Secondary outcome measures were the rate of visual recovery and complications. Results The mean age in years (PT: 58.5 ± 9.8, Phaco:61.6 ± 8.9; p = 0.16), preoperative mean deviation in decibel (PT: -18.7 ± 9.3; Phaco: -16.6 ± 7.9; p = 0.32) and the mean follow up in years (PT: 2.5 ± 1.8; Phaco: 2.8 ± 2.0; p = 0.63) were similar in the two groups. The mean preoperative AGMs were more in the PT group (PT: 2.13 ± 0.97, Phaco: 1.60 ± 0.78; p = 0.01). In both the groups the survival was similar at all-time points (PT: 78% at 1-year and 52% at 5-years, Phaco: 80% at 1 year and 59% at 5 years (P = 0.82). The postoperative visual acuity in LogMAR was significantly better in the Phaco group at 1 month (PT: 0.22 ± 0.38, Phaco:0.06 ± 0.07; p = 0.02). Postoperative AGM (p = 0.68) and rate of visual field progression PT: -0.46 ± 0.41 dB/year; Phaco: -0.38 ± 0.73 dB/ year; p = 0.67) were similar in both groups. One eye in PT group developed malignant glaucoma which resolved with laser hyaloidotomy and cycloplegic therapy. Conclusions More rapid visual recovery with similar IOP control and similar visual field stability favor phacoemulsification to phacotrabeculectomy in medically controlled PACG eyes with cataract.

One-Year Results of a Multicenter Study: Intraocular Pressure–Lowering Effect of Combined Phacoemulsification, Goniosynechialysis, and Goniotomy for Cases of Advanced Primary Angle-Closure Glaucoma With Cataract

“…A few surgical complications were observed. This study found that compared with PEI alone or PEI+GSL in PACG with cataract, 11,12,15 additional GT with PEI+GSL contributed to a higher success rate. This finding was consistent with a small-scale RCT, which found that PEI +GSL+GT yielded better IOP control than PEI+GSL.…”

Phacotrabeculectomy vs Phacoemulsification Glaucoma coexist Cataracts: a Meta-analysis of randomized controlled trials

“…We divided 1 study into ab interno group which was conducted by Kahook-Dual blade technique. Finally, we pooled 10 studies to the nal Meta-analysis [1][2][3][4][5][6][7][8][9][10]. Characteristics of the included studies is shown in Table 1.…”

“…An explanation, the authors noticed, is maybe the phacotrabeculectomy allows a superior effect 24-hour intraocular pressure control and plays a favorable role in antagonizing postoperatively intraocular spikes. The other three studies [4,5,9], contrarily, recorded no difference preoperatively, postoperatively, and between the two groups.…”

“…In the anterior chamber depth and trabecular meshwork area, one included study showed that, in primary angle-closure, anterior chamber depth is similar between the phacotrabeculectomy group and phacoemulsi cation group in 6 months after surgery, and intraocular pressure also no difference in 6 months [2]. Another included study showed both groups have all-time similar postoperative intraocular and angle open quadrants in primary angle-closure glaucoma [9]. This may show two procedures both depth the anterior chamber in angle-closure glaucoma or primary acute angle closed, and more results in angle opened glaucoma are warranted.…”

“…Complications 10 studies were included in this part [1][2][3][4][5][6][7][8][9][10]. Complications range from intraoperative complications to postoperative complications.…”