Phaco Plus Trabeculectomy Visual Recovery Slower Than Phaco After Trabeculectomy

Rates of intraoperative complications, cystoid macular edema (CME), and visual improvements are similar between patients who receive cataract extraction combined with trabeculectomy (phaco+trab) compared with patients who undergo cataract extraction after prior trabeculectomy (post-trab phaco), according to research presented at the American Glaucoma Society’s 2024 Annual Meeting held in Huntington Beach, CA, from February 29 to March 3, 2024. However, the phaco plus trabeculectomy patients had a slower visual recovery than those who underwent prior trabeculectomy, the researchers noted.

Trabeculectomy is a gold-standard procedure for conjunctival bleb-forming glaucoma. However, the procedure is associated with cataract formation or progression and the relationship between outcomes and timing of phacoemulsification during or after trabeculectomy is unclear. 

The purpose of this retrospective, nonrandomized study presented by Joseph Toma, MD, PhD, and colleagues was to compare the visual outcomes and rates of intraoperative complications and CME in eyes that underwent phaco plus trabeculectomy (n=610; mean age, 75.7[11.1] years; 56.6% women) compared with post-trabeculectomy phaco (n=636; mean age, 74.9[10.7] years; 52.5% women).

Postoperative visual recovery was slower in the phaco plus trabeculectomy group, with the combined approach taking 12 to 24 weeks to reach the level of recovery that patients who received separate procedures reached in 4 to 12 weeks. However, visual improvements were similar for both groups at the 6 month follow-up (0.34 vs 0.31). Rates of intraoperative complications such as posterior capsular ruptures (5 vs 6; P =.08) and CME (3 vs 7; P =.229) were also similar in both groups. 

Iris prolapse occurred in 4 of the patients who underwent the combined phaco plus trabeculectomy procedure, but it was not seen in any patients who underwent cataract extraction after trabeculectomy. Conjunctival buttonholes were also seen in 4 patients who underwent the combined procedures, but not in the post-trab phaco group.

The presenters concluded that the 2 surgical approaches were similar with respect to visual improvements and complications.