Complications Of Phacoemulsification Vs Phacotrabeculectomy In The Treatment Of Chronic Angle Closure Glaucoma With Concomitant Cataract

Aim: To assess whether phacoemulsification or phacotrabeculectomy (with adjunctive Mitomycin C) is the surgery of choice in eyes with chronic angle closure glaucoma (CACG) with concomitant cataract.

Method: Patients with CACG and coexisting cataract were randomized into 2 groups, comparing phacoemulsification (Group A) versus combined phacotrabeculectomy with adjunctive Mitomycin C (Group B). Group A had 62 eyes of medically controlled CACG with Cataract and 56 eyes of medically uncontrolled CACG with cataract. Group B had 55 eyes of medically controlled CACG with Cataract and 59 eyes of medically uncontrolled CACG with cataract. The 2 groups had identical study designs. All patients were reviewed three-monthly for two years after surgery. The main outcome measure was the surgical complications of phacoemulsification versus phacotrabeculectomy in CACG eyes with cataract

Result: In Group A, five(4.2%) of the 118 eyes reported four surgical complications while in Group B, eighteen(15.8%) of the 114 eyes had sixteen surgical complications. The difference in the proportion of eyes with one or more surgical complications between the two groups was statistically significant (P=. 003, 95% CI) *. In addition to this the risk of surgical complication with phacotrabeculectomy was significantly higher when compared to phacoemulsification [3.73 (p=0. 003, 95%CI, 1.43-9.70)] *. There was no statistically significant difference in final visual acuity or glaucomatous progression during the 24 month follow-up, between two groups.

Conclusion: Phacoemulsification resulted in significantly less surgical complications than phacotrabeculectomy in CACG eyes with coexisting cataract. There was no difference in visual acuity or disease progression between the 2 groups.

* Fisher's Exact Test