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Objective <p>To assess the long-term (4 year) outcomes of staged (phacoemulsification <InlineEquation ID="IEq1"> <EquationSource Format="TEX">\( \ge \)</EquationSource> </InlineEquation>6 months prior to trabeculectomy) or combined (phacotrabeculectomy) surgical approaches in patients with uncontrolled glaucoma.</p> Methods and Analysis <p>Patients who underwent trabeculectomy alone (with phacoemulsification at least 6 months before trabeculectomy - staged approach) and simultaneous phacotrabeculectomy (combined approach) were included in this retrospective chart review study. Surgical success was defined as complete (without medication) or qualified (with medication) according to 3 criteria of upper limits: intraocular pressure (IOP) &gt; 21 mmHg (criterion A), &gt; 18 mmHg (B), &gt; 15 mmHg (C). Mean IOP values were compared between groups at each follow-up.</p> Results <p>A total of 72 patients (staged <i>n</i> = 35, combined <i>n</i> = 37) were included. No differences in baseline characteristics were observed between groups. The mean age was 72.3 years, almost three-quarters were diagnosed with primary open-angle glaucoma (73.6%), and mean baseline IOP was 26.4 ± 7.2. Mean IOP significantly decreased in both groups. After 4 years of follow-up, patients in the staged group had a significantly lower mean IOP (10.9 ±3.6 vs. 14.8 ± 6.2, p 0.002), a higher surgical success rate according to each criterion, and a lower need of postoperative drugs and manipulation compared to the combined approach.</p> Conclusion <p>In this study comparing staged and simultaneous approaches with the longest follow-up to date, patients with cataract and glaucoma experience a substantial and comparable reduction in IOP from baseline after both approaches. The analysis is mainly limited by its retrospective, non-randomized design. However, compared to simultaneous phacotrabeculectomy, the staged approach was associated with lower final IOP, higher long-term surgical success, and fewer postoperative interventions.</p>

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Long-term outcomes after phacoemulsification and trabeculectomy in uncontrolled glaucoma and cataract in staged versus combined approaches: a single-center observational study

  • 期刊论文

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  • 发表日期：

    2026年2月9日

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  • Matteo Sacchi,
  • Gianluca Monsellato,
  • Davide Rastelli,
  • Shadan Ranaei,
  • Davide Tomaselli,
  • Gaia Li Calzi,
  • Edoardo Villani,
  • Stefano Dore,
  • Antonio Pinna,
  • Paolo Nucci

摘要

Objective

To assess the long-term (4 year) outcomes of staged (phacoemulsification \( \ge \) 6 months prior to trabeculectomy) or combined (phacotrabeculectomy) surgical approaches in patients with uncontrolled glaucoma.

Methods and Analysis

Patients who underwent trabeculectomy alone (with phacoemulsification at least 6 months before trabeculectomy - staged approach) and simultaneous phacotrabeculectomy (combined approach) were included in this retrospective chart review study. Surgical success was defined as complete (without medication) or qualified (with medication) according to 3 criteria of upper limits: intraocular pressure (IOP) > 21 mmHg (criterion A), > 18 mmHg (B), > 15 mmHg (C). Mean IOP values were compared between groups at each follow-up.

Results

A total of 72 patients (staged n = 35, combined n = 37) were included. No differences in baseline characteristics were observed between groups. The mean age was 72.3 years, almost three-quarters were diagnosed with primary open-angle glaucoma (73.6%), and mean baseline IOP was 26.4 ± 7.2. Mean IOP significantly decreased in both groups. After 4 years of follow-up, patients in the staged group had a significantly lower mean IOP (10.9 ±3.6 vs. 14.8 ± 6.2, p 0.002), a higher surgical success rate according to each criterion, and a lower need of postoperative drugs and manipulation compared to the combined approach.

Conclusion

In this study comparing staged and simultaneous approaches with the longest follow-up to date, patients with cataract and glaucoma experience a substantial and comparable reduction in IOP from baseline after both approaches. The analysis is mainly limited by its retrospective, non-randomized design. However, compared to simultaneous phacotrabeculectomy, the staged approach was associated with lower final IOP, higher long-term surgical success, and fewer postoperative interventions.