Outcomes of Combined Paco-Trabeculectomy Versus Sequential Procedures in Patients with Coexisting Cataract and Glaucoma

Abstract

Objective: To compare the outcomes of combined phaco-trabeculectomy versus sequential procedures in patients with coexisting cataract and glaucoma in terms of visual acuity, intraocular pressure control, postoperative complications, and requirement of anti-glaucoma medications.

Study Design: Prospective Comparative study.

Place and Duration of Study: Department of Ophthalmology, Lahore General  Hospital, Lahore from October 2023 to July 2024.

Methodology: A total of 350 patients aged 40–80 years diagnosed with coexisting cataract and glaucoma were included in the study. Patients were divided into two groups. Group A underwent combined phaco-trabeculectomy, while Group B underwent sequential procedures. Baseline demographic and clinical characteristics were recorded before surgery. Patients were followed regularly to evaluate visual acuity, intraocular pressure, surgical success, postoperative complications, and requirement of anti-glaucoma medications. Data were analyzed using SPSS version 25.0. Quantitative variables were expressed as mean ± standard deviation, while qualitative variables were presented as frequency and percentage.

 Results: The visual acuity and intraocular pressure of the patients that underwent combined phaco-trabeculectomy were statistically significantly improved following surgery. The sequential procedure group also improved; but combined surgery resulted in earlier control of pressure and less need for anti-glaucoma drugs. There were few and manageable postoperative complications in both groups, including transient inflammation, shallow anterior chamber, and transient increase in intraocular pressure. Combined phaco-trabeculectomy was more successful than surgery alone in achieving overall success. Conclusion: Phaco-trabeculectomy was effective and was a safe procedure for the patients who had both cataract and glaucoma at the same time. It was associated with a better visual outcome, a better control of intraocular pressure and reduced medication use compared to sequential procedures.