Outcomes of combined cataract extraction, lens implantation, and trabeculectomy surgeries

Abstract

Purpose: To report outcomes and their association with preoperative and intraoperative factors of 456 combined cataract and glaucoma operations.

Methods: A concurrent series (from January 1, 1987, to October 1, 1997) of one surgeon's consecutive 585 (456 patients) combined cataract extraction, intraocular lens implantation, and trabeculectomy surgeries, some with intraoperative mitomycin C and/or postoperative subconjunctival 5-fluorouracil. The study was a retrospective outcomes analysis for the first 191 operations (before June 10, 1992) and, subsequently, concurrent outcomes analysis for the latter 394 operations. Main outcome measures included postoperative visual acuity, intraocular pressure, number of glaucoma medications, intraoperative and postoperative adverse event rates, and reoperation for glaucoma or other ocular surgical or laser intervention.

Results: Visual acuity was improved at the time of last follow-up in 402 (88.2%) of 456 first operated eyes of the 456 patients. Increasing age (coefficient = 0.025; CI [confidence interval], 0.017 to 0.33; P <.0001) was associated with a decreased likelihood of improved visual acuity, and a more recent operation (coefficient = 0.0037; 95% CI, -0.0064 to -0.0010, P =.0082) was associated with an increased likelihood of improved visual acuity. Forty-one (9.0%) of 456 eyes had reoperation to control intraocular pressure. Glaucoma reoperation was most strongly associated with a preoperative diagnosis other than primary open-angle, pigmentary, or pseudoexfoliative glaucoma, a history of previous ocular surgery, and high preoperative intraocular pressure. Mean intraocular pressure reduced 5.5 mm Hg from 21.8 mm Hg preoperatively to 16.3 mm Hg postoperatively and mean glaucoma medication from 2.0 to 0.9 medications. Mitomycin C or 5-fluorouracil use was significantly associated with a lower postoperative intraocular pressure and reduced postoperative glaucoma medication. Major postoperative adverse event or other reoperation (not for glaucoma) occurred in 12 (2.6%) of first operated eyes.

Conclusions: Combined surgery outcomes in 456 first-operated eyes of 456 patients showed 88.2% improved visual acuity, 9% re-operation rate, 5.5 mm Hg mean intraocular pressure reduction, 1.1 glaucoma medication reduction, and a low major postoperative adverse event rate. Type of glaucoma, previous ocular surgery, and high preoperative intraocular pressure were the best predictors for the need for reoperation for glaucoma after combined surgery. Mitomycin C and/or 5-fluorouracil provided a greater reduction of mean intraocular pressure and glaucoma medication compared with patients not receiving these agents.