Prospective Randomized Comparison of One- versus Two-Site Phacotrabeculectomy

Correlation Between the Indiana Bleb Appearance Grading Scale and Intraocular Pressure After Phacotrabeculectomy

“…9 There was no significant difference between the 2 groups at baseline with a mean IOP of 17.6 mm Hg in both study arms (Table 1). At 2 years there was no statistically significant difference in IOP between the 2 groups with a mean IOP of 12.5 and 12.9 mm Hg in the 1 and 2-site groups, respectively.…”

“…The details of this study are described elsewhere but are summarized below. 9 The study was approved by the Research Ethics Board at the University Health Network, Toronto, Ontario, Canada. Inclusion criteria included patients scheduled for phacotrabeculectomy, more than 40 years of age, with good visual potential, absence of other serious ocular conditions, no previous ipsilateral ocular surgery aside from one previous trabeculectomy, and all glaucomas except for uveitis or neovascularization.…”

Corneal endothelial cell loss after trabeculectomy or after phacoemulsification, IOL implantation and trabeculectomy in 1 or 2 steps

“…Therefore, we show that the two-step procedure causes more damage to the endothelium than the one-step procedure. Various authors have studied the corneal endothelium after combined phacoemulsification, intraocular lens implantation and trabeculectomy, and found that CECD decreases by between 7 and 16% [22,23,25] and that there is less cell loss when the one-site versus two-site procedure is used [23,25]. We find more cell loss than these authors, and this may be due to our macrotrabeculectomy technique but also to patient age, because the patients who underwent combined two-step surgery were significantly older than those from the control or the trabeculectomy group.…”

“…This is due to the technique of our macrotrabeculectomy, because we use a limbus-based conjunctival flap and an 8×5 mm superficial scleral flap that makes it difficult to carry out phacoemulsification from the site of the trabeculectomy. Other authors, however, use one or two sites interchangeably, and have reported that both are similarly effective for lowering the intraocular pressure [23,24], but that there may be more endothelial cell damage when two-site surgery is used [23,25].…”

“…Cataract surgery [9,[12][13][14][15][16][17][18], trabeculectomy [19][20][21] and combined phacoemulsification, intraocular lens implantation and trabeculectomy [22][23][24][25] cause endothelial cell loss; however, there are very few studies on this subject, and none has compared the effects of the combined method when the one-or two-step procedures are used.…”