Comparison of Trabeculectomy with combined PhacoTrabeculectomy in the treatment of Angle closure Glaucoma

Background: Trabeculectomy has always been a mainstream treatment in reducing intraocular pressure (IOP) for primary angle closure glaucoma (PACG); combined Trabeculectomy and Phacoemulsification surgery was reported to reduce IOP and simultaneously improve vision for patients with coexisting cataract. Objective: This study was designed to compare the efficacy and safety of combined phacotrabeculectomy with that of trabeculectomy alone in the treatment of PACG with coexisting cataract. Methods: A hospital based observational prospective study was carried out on 64 eyes of 56 patients with PACG and coexisting cataract were enrolled in the study. Of these, 32 eyes underwent phacotrabeculectomy while the other 32 eyes went trabeculectomy alone. IOP, filtering blebs, complications, visual acuity and number of anti-glaucoma medications use after surgery were compared at the final follow-up. Complete success was defined as IOP less than 16 mmHg or IOP reduction of <30% without IOP lowering medications. All the data’s collected were used for the statistical analysis using the Microsoft Excel and SPSS version 21.0 Results: A total of 64 eyes out of 56 patients got operated, of which 32 eyes underwent trabeculectomy alone and the remaining 32 eyes got phacotrabeculectomy done. After 3 months of postoperative period, 2 patients lost to follow-up, the phacotrabeculectomy and trabeculectomy group showed no significant differences in IOP reduction (18.6 ± 15.66 vs 29.13 ± 14.15), complete success rate (86.66% vs 80%), functioning blebs (62.5% (10/15) vs 75% (12/15), and complications (18.75% (3/16) vs 25% (4/16) respectively. IOP lowering medications was not required for most of the patients in both the groups (13.33% (2/15) vs 13.33% (2/15). Additional surgery interventions were needed including opening of the ostium (6.66% (1/15) and bleb needling (13.33% (2/15) were needed in the trabeculectomy group, whereas no surgery was needed postoperatively in the phacotrabeculectomy group except 3 doses of 5 FU in one patient (6.66% (1/15). Improve in best corrected visual acuity was seen in phacotrabeculectomy group (0.40 ± 0.23) preoperatively to (0.20± 0.14) postoperatively (p=0.002). Conclusion: Phacotrabeculectomy and Trabeculectomy exhibit similar IOP reduction, success rates and complications when it comes to treating angle closure glaucoma patients with coexisting cataracts, although additional surgical intervention may be needed for a few cases with cataract and complications after trabeculectomy. The visual acuity improvement was observed in the post operative period after phacotrabeculectomy.