Single versus Two-Site Phacoemulsification and Mitomycin-C Trabeculectomy

PURPOSE: To compare the outcomes of single-site versus two-site mitomycin-C (MMC) augmented phacotrabeculectomy. METHODS: This matched randomized clinical trial included 34 eyes of 30 patients with visually significant cataracts and poorly controlled glaucoma. Equal numbers of eyes were randomly assigned to the single-site and two-site groups. In the single-site approach, phacoemulsification was performed under a superior scleral tunnel followed by trabeculectomy. The two-site approach included a temporal clear corneal phaco-emulsification combined with a separate superior trabeculectomy. MMC 0.2 mg/ml was similarly applied for one minute in both groups. RESULTS: Patients were followed for a mean period of 13±1.4 (range, 12 to 15) months. Mean best corrected visual acuity one year after surgery was 0.6±0.4 LogMAR in the single-site group and 0.4±0.28 LogMAR in the two-site group (P=0.12). In the single-site group, mean preoperative intraocular pressure (IOP) was 26.4±6.6 mmHg which was decreased to 14.8±2.5 mmHg, one year after the operation (P < 0.001). Corresponding figures for the two-site group were 22.9±3.3 and 13.6±1.7 mmHg respectively (P < 0.001). At final follow up no significant difference in IOP existed between the study groups. Mean number of anti-glaucoma medications was 0.06±0.24 in the two-site group vs 0.43±0.5 in the single-site group (P=0.014). The rate of complications was not different between the study groups (P=1). CONCLUSIONS: Both single-site and two-site phacotrabeculectomy improved visual acuity which was slightly, but not significantly, better with two-site surgery. Final IOP was comparable with both techniques; however, the two-site group required fewer antiglaucoma medications.