Combined trabeculectomy and phacoemulsification: a one-site vs a two-site approach.

Purpose: To compare the results of combined trabeculectomy and phacoemulsification surgery with intraocular lens implant by means of a one-site vs a two-site approach.

Methods: Glaucomatous patients with a coexisting cataract were randomly assigned to undergo either a one-site or two-site combined procedure. One-site surgery was performed with a limbus-based conjunctival flap and scleral tunnel at the 12-o'clock position. Two-site surgery was performed with a limbus-based conjunctival flap for the trabeculectomy in the superior nasal quadrant and a temporal clear cornea incision for phacoemulsification. Mitomycin C (0.4 mg/ml for 2 minutes) was applied to the scleral surface at the trabeculectomy site for both approaches. All patients received intraocular lens implants at the time of combined surgery.

Results: Thirty-three eyes of 33 patients were included in this study. Preoperative intraocular pressure and number of glaucoma medications were similar in the two groups. Corrected visual acuity improved similarly in both groups. Intraocular pressure decreased in both groups at last follow-up but was not significantly different (P = .129) between the one-site and two-site groups. At last follow-up, the one-site group required significantly more (P = .030) medications than did the two-site group.

Conclusions: Combined trabeculectomy and phacoemulsification surgery in which one-site and two-site techniques were used yielded similar improvements in corrected visual acuity and intraocular pressure reduction. However, the one-site group required more medication to maintain intraocular pressure control than did the two-site group.