Comparison of three methods for glaucoma with a cataract

Objective To compare three types of microsurgery on management of glaucoma com-bined with a cataract.Methods The indications of three types of microsurgery were set up for a non-random-ized comparison study on 152 eyes (135 cases) with acute or chronic glaucoma and coexisting cataracts which were performed trabeculectomy only, NF trabeculectomy plus intraocular lens implantation, NF with IOL.The eyes were categorized into three groups according to whether staged procedure, one procedure or combined procedure.Group A: 36 eyes with staged procedure, after successful trabeculectomy, underwent cataract surgery by NF techniques and intraocular lens implantation.The average time from initial trabeculectomy to cataract surgery was 24.2 mo.Group B: 98 eyes with triple procedure, cataract surgery by NF techniques and intraocular lens implantation combined with trabeculectomy with peripheral iridectomy.Mean follow-up was 12±1 mo.Group C: 18 eyes with one procedure, cataract surgery by NF techniques and intraocular lens im-plantation only.The postoperative visual acuity, intraocular pressure (IOP) and corneal endothelial cell among the three groups were analyzed and compared.Results Of the three groups, the patients with VA better than 0.2 improved statistically after operation (x~2=16.00, P<0.01).Mean intraocular pressure was lowered signifi-cantly in Group A and Group B (t_1=1.89, P_1=0.01; t_2=2.87, P_2=0.03).In Group C, there was no significantly difference with post-operation and pre-operation (t=0.43, P=0.78).As to corneal endothelial cell, there was no statistically significant difference among the three groups (P≥0.05).No severe intra-operative complications happened in three groups.Two eyes with mildest postoperative inflammatory response were seen in Group B.There were 17 eyes happened low-grade to moderate corneal edema in Group B and 5 eyes in Group C.Con-clusions Various surgery techniques for glaucoma with a cataract should be chosen depending on the dif-ferent conditions.Only if we recognize correctly the type of glaucoma and know accurately the stage and cause of cataract, can we select the most effective therapy with lowest complications and optimal surgery outcome. Key words: Glaucoma;  Cataract;  Trabeculectomy;  NF;  IOL