• Glaucoma

    There is an assumption that surgery for primary angle-closure glaucoma is associated with greater risk of postoperative complications, but to date no study has compared postoperative complication rates between  PACG and POAG. This retrospective study found that PACG had no higher incidence of  complications in the first year after either trabeculectomy or phacotrabeculectomy than patients with POAG.

    The authors analyzed the charts of 446 subjects with PACG and 816 subjects with POAG who underwent trabeculectomy or phacotrabeculectomy at the same Singapore hospital.

    Postoperative complications occurred in 65 eyes (5.3 percent), with no significant difference between the groups overall (POAG, 4.8 percent; PACG, 5.8 percent). The reoperation rate was also similar (POAG, 2.7 percent; PACG, 4 percent). However, the complication rate in the trabeculectomy group was more than double that of the phacotrabeculectomy group ( 8.4 percent vs. 4 percent).

    Many of the complications found were caused by specific problems usually unrelated to the underlying diagnoses. They found that trabeculectomy resulted in a significantly higher overall reported incidence of postoperative complications compared with phacotrabeculectomy (P=.003). However, statistical analyses between the two groups yielded no significant differences for individual complications except for bleb leak (P = 0.008).

    One important aspect the study didn't consider was success rates, which are important for several reasons. The phaco component can potentially impact angle-closure patients more, and the "trade-off" of lower IOP with trabeculectomy alone vs. phacotrabeculectomy becomes muddied in that there were more hypotony complications in the trabeculectomy group.  This needs to be offset with relative efficacies.