Trabeculectomy followed by phacoemulsification versus trabeculectomy alone: The Collaborative Bleb-Related Infection Incidence and Treatment Study

This study aims to compare the rate of surgical failure after trabeculectomy followed by phacoemulsification vs trabeculectomy alone for 5 years. A total of 1,098 eyes of patients with glaucoma who underwent trabeculectomy with mitomycin C at 34 clinical centers included in CBIITS were analyzed. During follow-up, some eyes were treated with phacoemulsification because of cataract progression. The patients were divided into the "trabeculectomy followed by phacoemulsification" and "trabeculectomy alone" groups, and surgical probabilities were compared. Surgical failure was defined on the basis of mean IOP as follows; < 20% reduction in preoperative IOP or IOP ≥ 21 mmHg (criterion A), IOP ≥ 18 mmHg (criterion B), or IOP ≥ 15 mmHg (criterion C). In total, 40 eyes were treated with trabeculectomy followed by phacoemulsification and 208 with trabeculectomy alone. Preoperative intraocular pressure was 22.1 ± 8.7 mmHg in the trabeculectomy followed by phacoemulsification group and 20.5 ± 6.3 mmHg in trabeculectomy alone group (P = 0.47). The 5-year cumulative probabilities of success in the trabeculectomy followed by phacoemulsification and trabeculectomy alone groups were respectively 40.0% and 59.1% for criterion A (P = 0.01), 35.0% and 52.9% for criterion B (P = 0.01), and 25.0% and 37.5% for criterion C (P = 0.08). Cox proportional hazards regression model indicated that shorter time gap between trabeculectomy and phacoemulsification was associated with surgical failure. Phacoemulsification following trabeculectomy adversely affects surgical outcomes. In particular, a shorter time gap between trabeculectomy and phacoemulsification reduces the probability of success.