Long‐Term Efficacy of Phacoemulsification Combined With Trabeculectomy for Advanced Chronic Primary Angle‐Closure Glaucoma With Cataract: A 3‐Year Retrospective Study

Abstract

Purpose To evaluate the long‐term efficacy of phacoemulsification combined with trabeculectomy (Phaco‐Trab) for advanced chronic primary angle‐closure glaucoma (PACG) with cataract. Methods Patients with advanced chronic PACG coexisting with cataracts who underwent Phaco‐Trab were enrolled. The morphologic structures of filtering blebs, including characteristics under slit‐lamp examination, anterior segment optical coherence tomography (AS‐OCT), and in vivo confocal microscopy (IVCM), were used to evaluate the filtering function. Results A total of 30 eyes from 27 patients were enrolled. The mean preoperative intraocular pressure (IOP) of 19.98 ± 6.48 mmHg significantly decreased to 13.73 ± 2.35 mmHg at year 3 (p < 0.0001). A statistically significant decrease in postoperative IOP‐lowering medications was observed, but the number of drugs used increased annually (0.50 ± 0.82 at year 1, 1.00 ± 0.98 at year 2, and 1.47 ± 0.97 at year 3, p < 0.0001). Following Phaco‐Trab, a high surgical qualified success rate was maintained over 3 years (93.3% at year 1, 90.0% at year 2, and 80.0% at year 3, p = 0.117). However, the complete success rate significantly decreased each year (70.0% at year 1, 36.7% at year 2, and 20.0% at year 3, p < 0.0001), along with an increase in the rate of failure filtering blebs, reaching 46.7%, 83.3%, and 90.0% at each time point (p < 0.0001). Overall, 46.7% (14/30) of participants developed complications and required postoperative procedures after Phaco‐Trab, which were mainly induced by the trabeculectomy procedure. Conclusions Phaco‐Trab can significantly lower IOP and reduce the use of IOP‐lowering medications for advanced chronic PACG with cataracts, but it is associated with a higher rate of complications and a higher failure rate of the filtering bleb.