Trabeculectomy and phaco-trabeculectomy with and without peripheral iridectomy

Abstract

Purpose: To compare the 1-year outcome of trabeculectomy and combined phaco-trabeculectomy that were performed with or without a peripheral iridectomy (PI).

Methods: In a large tertiary glaucoma clinic, with a single surgeon performing all surgeries, 47 patients scheduled to undergo either a primary trabeculectomy or phaco-trabeculectomy were prospectively randomized to surgery with or without peripheral iridectomy. Other than the inclusion (PI group) or omission (no PI group) of a PI, surgical technique and postoperative care were identical for the two groups. The two groups were compared for intraocular pressure (IOP), success rates, visual acuity (VA), and complication rates. Complete and qualified success rates were defined as IOP 18 mmHg or less with or without medications, respectively.

Results: The 1-year complete and qualified success rates were comparable for both groups. Complete success was observed in 70% of cases, and qualified success in more than 90%. One patient (4.3%) from the no-PI group developed an iris incarceration into the internal sclerectomy site on postoperative day 1, requiring surgical intervention. No other significant complications (blebitis, endophthalmitis, or choroidal hemorrhage) were encountered in any of the study patients.

Conclusions: This randomized prospective small scale study explored the possibility of sparing the need to perform a routine PI in trabeculectomy and phaco-trabeculectomy. These preliminary results suggest that the outcomes in the two groups are comparable, paving the way to a larger scale study evaluating the need for PI in modern trabeculectomy surgery.