Long-term outcomes of combined cataract extraction and trabeculotomy by the internal approach (Trabectome) for coexisting cataract and open-angle glaucoma (5 Years follow-up)

Purpose: To provide the long-term efficacy and safety of surgery with Trabectome combined with phacoemulsification in primary open-angle glaucoma over 5 years.Methods: In this prospective, interventional case series, 18 consecutive eyes that have had combined phacoemulsification with Trabectome were included. The main outcome measures were change in intraocular pressure (IOP), glaucoma medication use, surgical reintervention rate and the rate of complications.Results: Mean preoperative IOP was reduced from 17.67 ± 3.91 mmHg to 13.78 ± 2.31 mmHg at one year and to 15.0 ± 3.21 mmHg at five years (P < 0.05). There was a corresponding drop in glaucoma medications from 2.31 ± 0.60 at baseline to 1.00 ± 0.48 at one year and 1.17 ± 0.70 mmHg at five years (P < 0.01). The pre-operative BCVA (Log Mar) was improved from 0.60 ± 0.20 to 0.09 ± 0.14 at one year, and 0.12 ± 0.14 at five year post-operatively (P < 0.01). The only frequent complication was transient blood reflux resolving within a few days, spontaneously. No vision-threatening complication occurred. More than 20% reduction of IOP was seen in 55.6% at one year and 38.9% at five years post operatively.Conclusion: Combined phacoemulsification and Trabectome significantly lowers IOP and use of glaucoma medication, and provide early visual rehabilitation with long-term stable outcomes