A recent study found that phacotrabeculectomy was more effective in reducing intraocular pressure (IOP) and glaucoma drugs than phacoemulsification alone in primary angle-closure glaucoma (PACG) patients with cataracts for up to five years after surgery; however, the procedure was associated with more postoperative complications. 

The researchers analyzed clinical data of 35 phacoemulsification patients and 44 phacotrabeculectomy patients and found that the mean IOP was decreased by 20.7% and 29.5% at the five-year post-op in each respective group. In the 83.9% of phacoemulsification eyes that did not require subsequent trabeculectomy during follow up, the mean number of drugs decreased by 48.1%. The mean number of drugs decreased by 73.1% in the phacotrabeculectomy group.

Nevertheless, the phacotrabeculectomy group experienced a total of 25 complications in the five years post-op, compared with just six in phacoemulsification group.

The researchers are uncertain whether phacotrabeculectomy’s advantage in IOP lowering could be maintained long term. Still, the study suggests that doctors educate patients who are offered phacotrabeculectomy of the possible higher risk, so they can make an informed decision. Patients who should carefully weigh their options include the elderly, those at advanced disease stages and those with uncontrolled IOP preoperatively.

Hansapinyo L, Choy BNK, Lai JSM, Tham CC. Phacoemulsification versus phacotrabeculectomy in primary angle-closure glaucoma with cataract: long-term clinical outcomes. J Glaucoma. November 6, 2019. [Epub ahead of print].