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One Site as Good as Two for Phacotrabeculectomy

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Outcomes in patients with coexistent glaucoma and cataracts who undergo simultaneous trabeculectomy and lens extraction are no different whether the two procedures are performed through one incision or two, a meta-analysis shows.

Dr. Yvonne M. Buys at Toronto Western Hospital, Ontario, Canada and colleagues explain in an August 5th online issue of Ophthalmology that the last systematic review of the surgical management of coexisting cataract and glaucoma found weak evidence that 2-site phacotrabeculectomy produced a 1- to 2-mm Hg lower intraocular pressure (IOP) than 1-site surgery.

There have been several new publications on this topic, so the investigators conducted a meta-analysis of data from 10 relevant studies. The pooled results showed that differences in the mean IOP reduction between 1-site and 2-site phacotrabeculectomy were not statistically different, based on the overlap of their 95% confidence intervals.

Specifically, the authors report, “The IOP decreases from baseline (95% CI) were: 7.85 mmHg (6.76– 8.92 mmHg) versus 5.83 mmHg (4.72– 6.94 mmHg) at 1 month; 8.03 mmHg (7.38–8.67 mmHg) versus 7.03 mmHg (6.35–7.71 mmHg) at 3 months; 7.78 mmHg (7.14–8.42 mmHg) versus 6.75 mmHg (6.04–7.46 mmHg) at 6 months; 6.44 mmHg (5.47–7.41 mmHg) versus 6.68 mmHg (5.56– 7.81 mmHg) at 12 months; 7.17 mmHg (6.45–7.89 mmHg) versus 6.56 mmHg (5.77–7.35 mmHg) at 24 months; and 7.76 mmHg (7.02– 8.49 mmHg) versus 7.14 mmHg (6.36– 7.92 mmHg) at 36 months for a 1- versus 2-site procedure, respectively.”

Similarly, there was no significant difference in glaucoma medication reduction between the two groups.

“The main message is that there is no evidence of any difference in IOP reduction or complication rate between one- or two-site phacotrabeculectomy,” Dr. Buys commented in an email to Reuters Health.”

While outcomes are comparable, however, other factors may influence the choice of a 1-site or 2-site operation, Dr. Buys and colleagues point out in their paper. Such factors include surgical access, orbit shape, surgeon experience, ergonomic comfort, and surgical time.

“The choice of one- versus two-site surgery would primarily be based on physician preference,” Dr. Buys advised. “There are however situations where two-site surgery would be preferred, for example if due to previous surgery or conjunctival scarring the location for the trabeculectomy is such that phacoemulsification would be difficult in the same location, then a two-site procedure would be preferable.”


Meta-analysis of 1- versus 2-Site Phacotrabeculectomy

Ophthalmology 2010.