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

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 investigat...

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Bibliographic Details
Published in:Current eye research 2022-06, Vol.47 (6), p.923-929
Main Authors: Davila, Jose R., Singh, Kuldev, Hernandez-Boussard, Tina, Wang, Sophia
Format: Article
Language:English
Subjects:
Adult
Cataract
Electronic Health Records
Glaucoma - etiology
Glaucoma - surgery
Glaucoma, cataract, trabeculectomy, phaco-trabeculectomy, combined surgery, intraocular pressure
Humans
Intraocular Pressure
Phacoemulsification - adverse effects
Retrospective Studies
Trabeculectomy - adverse effects
Treatment Outcome
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Summary: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. 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. 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. This study suggests there is no significant difference in the risk of TE failure in patients receiving TE versus those receiving PTE.
ISSN:0271-3683
1460-2202
DOI:10.1080/02713683.2022.2045611