Managing post acute congestive phase by combined manual small incision cataract surgery and trabeculectomy: a prospective study.

The purpose of the study was to evaluate the therapeutic efficacy of manual small incision cataract surgery (SICS) and trabeculectomy as management option for acute angle closure glaucoma. The first 6 cases of 14 cases of acute angle closure glaucoma seen over a period of 18 months underwent surgical peripheral buttonhole iridectomy (PBHI) after their intra-ocular pressure (IOP) was controlled medically. Subsequently 8 cases underwent manual SICS+trabeculectomy as an alternative procedure after their IOP control who needed further surgery and overall patients' comfort. The results showed sustained visual acuity remained 6/9 or better in all the patients of SICS + trabeculectomy group, compared 6/12 or worse in the PBHI group. Mean non-contact tonometry reading at the end of 6 weeks was 10.2 mm Hg in the second group compared to 14.6 in the first group. None of the patients in the second group ever needed surgery in a 4-month follow-up, whereas 3 patients in the first group had to be operated again for cataract or uncomplicated IOP. Manual SICS+ trabeculectomy offers a good, economical and rational therapeutic alternative to traditional PBHI in the postcongestive phase.