Phacotrabeculectomy and Implantation of Intraocular Lenses with Releasable Sutures and Antimetabolite Agents: Efficacy and Safety

Abstract Background: The aim of this study was to evaluate the efficacy and safety of phacoemulsification and the implantation of intraocular lenses (IOL) combined with trabeculectomy supplemented by releasable sutures and antimetabolite agents. Methods:Phacotrabeculectomy was performed in ۳۶ eyes of ۳۰ patients who hadmedically uncontrolled Intraocular pressure (IOP) or were nonreliable for medical therapy and had significant cataract, or had low Visual Activity (VA) due to cataract and simultaneous uncontrolled or medically controlled IOP with at least ۲ medications.  Mitomycin C (۰.۰۲%) for ۱-۳ minutes was applied in all cases. Scleral flap was sutured with permanent (loose) and releasable (tight) ۱۰-۰ nylon sutures. The releasable sutures were removed in the first to third postoperativeweeksif IOP was more than ۱۲mmHg. If bleb was vascularized or flat, and IOP was high or borderline (>۱۶mmHg), ۵FU was injected subconjunctivally ۱-۳ weeks after the surgery. If postoperative IOP was more than target pressure, antiglaucoma medications were used. Results:Eight eyes (۲۲.۲%) required releasable suture removal. Mean preoperative IOP was ۲۸.۴±۹.۴ (۱۲-۵۲) mmHg. Totally, ۳۳ eyes (۹۱.۷%) had primary open angle glaucoma, two eyes (۵.۵%) had posttraumatic glaucoma and one eye (۲.۸%) had exfoliative glaucoma (XFG). Mean postoperative final IOP was ۱۲.۱±۳.۹ (۵-۲۲) mmHg (p <۰.۰۰۰۱). Preoperative VA was ۰.۵mCF (log Mar=۲) to ۲۰/۲۰۰ (log Mar=۱). Mean VA was ۳mC.F (Log Mar=۱.۳±۰.۴). Postoperative VA was ۲۰/۲۰۰ (log Mar=۱) to ۲۰/۲۰ (log Mar=۰) and mean postoperative VA was ۲۰/۶۰ (log Mar=۰.۵۷±۰.۴۶) (p <۰.۰۰۰۱). Mean number of required medications to control IOP was ۲.۵۸±۰.۰۹ (۲-۴) preoperatively and ۰.۵۸±۰.۱۵ (۰-۳) postoperatively (p <۰.۰۰۰۱). Early postoperative complications were flat anterior chamber in ۳ eyes (۸.۳%), postoperative uveitis in ۳ eyes (۸.۳%) leakage in ۳ eyes (۸.۳%) and choroidal effusion in ۱ eye (۲.۸%). Conclusion: It seems, this method is an effective and safe procedure for patients with coexisting cataract and glaucoma.

Keywords:

Phacotrabeculectomy , Releasable suture , Antimetabolite agents