Outcomes of Single-Site Phacotrabeculectomy with Mitomycin C

To evaluate visual outcomes and intraocular pressure (IOP) after Single-site phacotrabeculectomy with mitomycin C in patients with senile cataract and primary open angle glaucoma (POAG), pseudoexfoliative glaucoma (PXG), or chronic angle closure glaucoma (CACG). In this retrospective study, patients older than 50 years who had significant cataracts (BCVA  20/60) and uncontrolled POAG, PXG, or PACG (IOP > 21 mmHg with at least two anti-glaucoma medications) were enrolled.Exclusion criteria included the presence of corneal pathologies, uveitis, diabetic retinopathy, neovascular orphacomorphic glaucoma, posterior segment pathologies, or a history of ocular trauma or intraocular surgery.Preoperative examination included uncorrected and best-corrected visual acuity (UCVA and BCVA, respectively),slit lamp biomicroscopy, IOP measurements, gonioscopy, and dilated funduscopy. The participants underwent single site phacotrabeculectomy with mitomycin C. Postoperative follow-up examinations were scheduled on days 1, 3, 7, and 14, and months 1, 3 and every 3 months thereafter. In each follow-up examination, the patients were re-evaluated for BCVA, IOP, the number of anti-glaucoma medications if needed, appearance of the bleb,and postoperative complications. Forty (24 right) eyes of 32 (12 female) patients with POAG (15 eyes), PXG (18 eyes), or CACG (7 eyes) were enrolled. Mean patient age was 739 (range, 46 to 88) years and the study groups were comparable in this regard (P=0.88). Mean postoperative follow-up period was 13.19.5 months, raging from 1 to 40 months. Of the participants, 6 had diabetes mellitus and 6 had systemic hypertension. Mean preoperative BCVA was 0.640.32 logMAR (20/80) which improved to 0.380.19 logMAR (20/50) postoperatively (P < 0.001). Preoperatively, mean IOP was 18.66.0 (range, 7 to 33) mmHg which was decreased to 12.33.0 (range, 6 to 17) mmHg postoperatively (P < 0.001).The PXG group demonstrated the highest reduction (P=0.001) and the POAG group experienced the lowest reduction (P=0.021) in IOP. At the last follow-up examination, the number of anti-glaucoma medications was reduced to 0.91.1, on average (P <0.001). The reduction in the number of medication was highest in the POAG (2.11.1, P=0.001) and lowest in the CAGC group (1.30.5, P=0.08). At final follow-up IOP was controlled with no medications in 21 eyes (52.5%), with timolol in 8 eyes (20%), and with 2 or more medications in 11 eyes (27.5%). With respect to intra- and postoperative complications and the appearance of the bleb, the study groups were comparable. One-site phacotrabeculectomy with mitomycin C is a safe and effective approach to decrease IOP and improve BCVA in patients with coexisting cataract and glaucoma.