One versus two-site phacotrabeculectomy

"If you have a patient whose corneal health is of special concern, you may want to consider one-site," said Dr. Yvonne Buys, MD, professor of medicine at the University of Toronto. 

At the recent 5th World Glaucoma Congress, Dr Buys reviewed the evidence for one versus two-site phacotrabeculectomy and discussed surgical approaches. 

While there are various options for patients with concurrent cataract and glaucoma, phacotrabeculectomy is the main choice for the more severe cases. 

A randomized, controlled trial of 79 patients she co-authored found when it came to IOP, visual acuity, and number of medications, there was no difference in outcome between one and two site patients. However, corneal endothelial cell counts proved to be better in the one-site patients at 3 and 12 months. 

"It's not surprising to see this kind of outcome. With one-site surgery you're a little bit more posterior entering the anterior chamber, and you're also having one less incision than in two-site surgery," she said. 

Another study Dr Buys co-authored was a meta-analysis which showed that after three years of follow-up, there were no differences between one and two-site surgery in lowering IOP, or in other measures. The only difference was that one-site surgery took less time to perform -- on average by 13 minutes. The meta-analysis included studies with similar patient populations. 

"Your choice comes down to what your preferred surgery is," said Dr Buys.