[Efficacy and safety of trabeculotome tunnelling trabeculoplasty with versus without phacoemulsification in patients with primary open-angle glaucoma and cataract].

Abstract

Objective: To compare clinical outcomes of combined trabeculotome tunnelling trabeculoplasty (3T) and phacoemulsification vs. 3T alone for primary open-angle glaucoma (POAG) with cataract. Methods: Retrospective cohort study. Patients with POAG and cataract who underwent 3T combined with phacoemulsification and intraocular lens implantation or 3T alone at Chengdu Integrated Traditional Chinese and Western Medicine Hospital between January 2023 and December 2024 were enrolled. They were divided into two groups according to surgical modality: the observation group with eyes receiving 3T combined with phacoemulsification and intraocular lens implantation and the control group with those receiving 3T alone. The intraocular pressure (IOP), best-corrected visual acuity [converted to logarithm of the minimum angle of resolution(logMAR)], number of antiglaucoma medications, and complications were recorded on postoperative day 1, week 1, month 1, month 3, and month 6, and the success rate at 6 months was evaluated. Results: There were 59 patients (71 eyes), with a mean age of (62.81±7.80) years, including 38 males and 21 females. The observation group comprised 35 eyes and the control group 36 eyes. The preoperative IOP was (23.76±5.01) mmHg (1 mmHg=0.133 kPa) in the observation group and (24.56±6.08) mmHg in the control group; at 6 months postoperatively, the IOP decreased to (15.28±2.80) mmHg and 15.00 (13.50, 18.00) mmHg, respectively. Both groups showed a significant IOP reduction from baseline (P<0.05), but the difference between groups was not statistically significant (P>0.05). At 6 months, the best-corrected visual acuity in the observation group improved significantly from baseline, with a mean improvement of 0.38 logMAR (P<0.05), whereas no significant improvement was observed in the control group (P>0.05). The number of antiglaucoma medications decreased postoperatively in both groups, with no statistically significant difference between groups (P>0.05). Regarding complications, the incidence of hyphema was 5.7% (2/35) in the observation group and 11.1% (4/36) in the control group, with no statistically significant difference (P>0.05). The incidence of IOP rebound was 20.0% (7/35) in the observation group, which was significantly lower than that in the control group (41.7%, 15/36) (P<0.05). At 6 months postoperatively, the overall success rate was 88.6% in the observation group and 80.6% in the control group, with no statistically significant difference (P>0.05). Conclusions: The 6-month follow-up results of this study indicate that 3T combined with cataract extraction is a safe and effective treatment for POAG with cataract, significantly improving visual acuity, effectively reducing IOP, and decreasing the number of antiglaucoma medications, with a low rate of postoperative complications.