Outcome of combined cataract extraction, len implantation, and trabeculectomy urgerie

PURPOE: To report outcome and their aociation with preoperative and intraoperative factor of 456 combined cataract and glaucoma operation. METHOD: A concurrent erie (from January 1, 1987, to October 1, 1997) of one urgeon’ conecutive 585 (456 patient) combined cataract extraction, intraocular len implantation, and trabeculectomy urgerie, ome with intraoperative mitomycin C and/or potoperative ubconjunctival 5-fluorouracil. The tudy wa a retropective outcome analyi for the firt 191 operation (before June 10, 1992) and, ubequently, concurrent outcome analyi for the latter 394 operation. Main outcome meaure included potoperative viual acuity, intraocular preure, number of glaucoma medication, intraoperative and potoperative advere event rate, and reoperation for glaucoma or other ocular urgical or laer intervention. REULT: Viual acuity wa improved at the time of lat follow-up in 402 (88.2%) of 456 firt operated eye of the 456 patient. Increaing age (coefficient = 0.025; CI [confidence interval], 0.017 to 0.33; P < .0001) wa aociated with a decreaed likelihood of improved viual acuity, and a more recent operation (coefficient = 0.0037; 95% CI, −0.0064 to −0.0010, P = .0082) wa aociated with an increaed likelihood of improved viual acuity. Forty-one (9.0%) of 456 eye had reoperation to control intraocular preure. Glaucoma reoperation wa mot trongly aociated with a preoperative diagnoi other than primary open-angle, pigmentary, or peudoexfoliative glaucoma, a hitory of previou ocular urgery, and high preoperative intraocular preure. Mean intraocular preure reduced 5.5 mm Hg from 21.8 mm Hg preoperatively to 16.3 mm Hg potoperatively and mean glaucoma medication from 2.0 to 0.9 medication. Mitomycin C or 5-fluorouracil ue wa ignificantly aociated with a lower potoperative intraocular preure and reduced potoperative glaucoma medication. Major potoperative advere event or other reoperation (not for glaucoma) occurred in 12 (2.6%) of firt operated eye. CONCLUION: Combined urgery outcome in 456 firt-operated eye of 456 patient howed 88.2% improved viual acuity, 9% re-operation rate, 5.5 mm Hg mean intraocular preure reduction, 1.1 glaucoma medication reduction, and a low major potoperative advere event rate. Type of glaucoma, previou ocular urgery, and high preoperative intraocular preure were the bet predictor for the need for reoperation for glaucoma after combined urgery. Mitomycin C and/or 5-fluorouracil provided a greater reduction of mean intraocular preure and glaucoma medication compared with patient not receiving thee agent.