Objective To assess the long-term (4 year) outcomes of staged (phacoemulsification 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.
Long-term outcomes after phacoemulsification and trabeculectomy in uncontrolled glaucoma and cataract in staged versus combined approaches: a single-center observational study / Sacchi, Matteo; Monsellato, Gianluca; Rastelli, Davide; Ranaei, Shadan; Tomaselli, Davide; Calzi, Gaia Li; Villani, Edoardo; Dore, Stefano; Pinna, Antonio; Nucci, Paolo. - In: BMC OPHTHALMOLOGY. - ISSN 1471-2415. - 26:(2026), pp. 1-12. [10.1186/s12886-026-04643-w]
Long-term outcomes after phacoemulsification and trabeculectomy in uncontrolled glaucoma and cataract in staged versus combined approaches: a single-center observational study
Sacchi, Matteo;Dore, Stefano;Pinna, Antonio;
2026-01-01
Abstract
Objective To assess the long-term (4 year) outcomes of staged (phacoemulsification 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.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
