Combined versus sequential phacotrabeculectomy with intraoperative 5-fluorouracil

Abstract

Purpose: To determine and compare the intraocular pressure (IOP) lowering effects of single-incision combined phacoemulsification and trabeculectomy with phacoemulsification done after previous trabeculectomy, both with an intraoperative dose of 5-fluorouracil (5-FU).

Setting: Hospital Del Salvador Ophthalmology Service, Clínica Oftalmológica Pasteur, Santiago, Chile.

Methods: The effects on IOP after phacoemulsification in eyes with previous trabeculectomy using intraoperative 5-fluorouracil (5-FU) (Group 1, n = 18) were compared with those in a matched group of eyes having combined phacoemulsification and trabeculectomy, also with intraoperative 5-FU (Group 2, n = 22). The mean postoperative IOPs and survival curves for IOP values less than 20 mm Hg and 15 mm Hg or less were determined in both groups. Data were retrospectively collected. Comparisons were made with the paired Student t test, and survival curves were compared using log-rank analysis.

Results: Mean postoperative IOP without medications was 12.6 mm Hg in Group 1 and 12.2 mm Hg in Group 2 (P = .64). Group 2 had a significant postoperative decrease in IOP (P = .0575); Group 1 did not have a significant increase or decrease. There was no significant difference in the survival curves between groups using arbitrarily defined failure criteria: (1) IOP greater than 15 mm Hg or (2) IOP equal to or greater than 20 mm Hg, both without medication (log-rank analysis, P = .333 and P = 1.00, respectively).

Conclusion: Combined cataract and glaucoma surgery with intraoperative 5-FU was associated with good long-term IOP control similar to that after phacoemulsification with intraoperative 5-FU in eyes with previous trabeculectomy.