Combined Phacoemulsification and Trabeculectomy with Midified Incision and Mitomycin C

Pongsak Pachimkul, M.D.

Pitsri Mukdasanit, M.D.

ABSTRACT Purpose : This study aimed to investigate the effects of creating a modified scleral tunnel incision in Mitomycin-augmented combined trabeculectomy and phacoemul-sification on intraocular pressure control and visual outcome.

Method : We conducted a prospective study of 73 eyes, with coexisting cataracts and glaucoma, which were treated with combined phacoemulsification with IOL implantation and trabeculectomy, with subconjunctival Mitomycin C.

Results : Pre-operatively ; the mean intraocular pressure was 22.94 ± 8.2 mm.Hg, the mean number of medications was 2.82 ± 0.82, the visual acuity ranged from 20/50 to hand movements, and the mean cup-disc ratio was 0.79. Post-operative, intraocular pressure was reduced to the mean of 8.15 ± 5.47 mm.Hg on the first post-operative day and 12.78 ± 4.03 mm.Hg at the end of follow up (20.6 months). Intraocular pressure was below 21 in all eyes with the mean munber of medications lowered to 0.48 ± 0.76, Visual acuity improved in 53 parients (72.6%) ; 30 (41%) achieved a visual acuity of 20/40 or better. Filtering bleb was observed in 55 eyes (75.3%). Major complications were hypotony and posterior capsule opacification.

Conclusion : The technique of modified incision in combined phacoemulsification and trabeculectomy with Mitomycin C can improve visual acuity and reduce intraocular pressure in patients with coexisting cataracts and glaucoma.

Thai J Ophthalmol 2000 : January-June 14(1) : 53-63.