Effect of Scleral Flap Size on Intraocular Pressure Outcomes Following Combined Phacoemulsification and Trabeculectomy

Aim: To compare intraocular pressure (IOP) outcomes following combined phacoemulsification and trabeculectomy using smaller and larger triangular scleral flaps. Methods: This prospective comparative study included 57 consecutive patients with coexisting glaucoma and cataract. Group A underwent surgery with a 3 ? 3 ? 3-mm scleral flap and foldable intraocular lens (IOL; n=22), whereas Group B received a 5 ? 4 ? 4-mm flap and non-foldable IOL (n=35). IOP was assessed preoperatively and at the last postoperative follow-up (4-12 months). Paired and independent-sample statistical tests were used for within-group and between-group comparisons. Results: Mean IOP decreased from 26.27 ± 10.82 to 14.23 ± 3.79 mmHg in Group A and from 24.57 ± 9.85 to 12.50 ± 3.95 mmHg in Group B. Median IOP reductions were 9.5 mmHg (IQR 5.5-17.5) and 10.0 mmHg (IQR 7.0-14.0), respectively (p=0.833). The between-group difference in mean reduction was 0.25 mmHg (95% CI -5.12 to 5.63; p=0.925). Conclusion: Both groups showed substantial postoperative IOP reduction, with no statistically significant between-group difference. However, confounding by IOL type and non-randomized allocation limits conclusions.