Outcomes of Primary Trabeculectomy versus Combined Phacoemulsification-Trabeculectomy Using Automated Electronic Health Record Data Extraction

Abstract

Purpose

Cataract is a known effect of trabeculectomy (TE), but some surgeons are hesitant to perform combined phacoemulsification-TE (PTE) due to a risk of increased TE failure. Herein, we compare intraocular pressure (IOP) lowering between trabeculectomy (TE) and phacoemulsification-TE (PTE) and investigate factors that impact patient outcomes.

Methods

We performed a retrospective study of adults undergoing primary TE or PTE at our institution from 2010 to 2017. We used Kaplan–Meier survival analysis to investigate time to TE failure, and Cox proportional hazards modeling to investigate predictors of TE failure, defined as undergoing a second glaucoma surgery or using more IOP-lowering medications than pre-operatively.

Results

318 surgeries (218 TE; 100 PTE) from 268 patients were included. Median follow-up time was 753 days. Mean baseline IOP was 21.1 mmHg. There were no significant differences in IOP between TE and PTE groups beyond postoperative year 1, with 28.9–46.5% of TE and 35.5–44.4% of PTE groups achieving IOP ≤10. Final IOP was similar in both groups (p = 0.22): 12.41 (SD 4.18) mmHg in the TE group and 14.05 (SD 5.45) in the PTE group. 84 (26.4%) surgeries met failure criteria. After adjusting for surgery type, sex, age, race, surgeon, and glaucoma diagnosis there were no significant differences in TE failure.

Conclusion

This study suggests there is no significant difference in the risk of TE failure in patients receiving TE versus those receiving PTE.

Keywords:

• Glaucoma, cataract, trabeculectomy, phaco-trabeculectomy, combined surgery, intraocular pressure

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available on request from the corresponding author, [S.Y.W.]. The data are not publicly available due to their containing information that could compromise the privacy of research participants.

Additional information

Funding

Supported by Research to Prevent Blindness, Inc, New York, New York, and the National Eye Institute, National Institutes of Health (grant no.: P30-026877 [S.Y.W.]); Research to Prevent Blindness Career Development Award [S.Y.W]; the National Library of Medicine, National Institutes of Health (grant no.: T15 LM 007033 [S.Y.W.]). The sponsors or funding organization had no role in the design or conduct of this research.