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Combined Approach to Phacoemulsification and Trabeculectomy Results in Less Ideal Refractive Outcomes Compared With the Sequential Approach

Purpose:To compare the refractive outcomes of combined versus sequential trabeculectomy and then phacoemulsification. Methods:We compared eyes that underwent uncomplicated combined phacotrabeculectomy (combined group, 87 eyes), phacoemulsification at least 3 months after trabeculectomy (sequential group, 56 eyes), and phacoemulsification only (control group, 78 eyes) between January 1, 2006 and January 1, 2014. The main outcome measure was refractive prediction error (RPE)—defined as postoperative subjective spherical equivalent refraction minus predicted spherical equivalent refraction. Results:The study population was predominantly Chinese and the mean age at their cataract surgery was 67.2±9.59 years. Compared with controls, RPE (−0.40±0.70 vs. −0.01±0.50, P<0.001) and mean absolute error (0.62±0.50 vs. 0.39±0.31, P=0.003) were greater for the combined group but not for the sequential group. Proportionately fewer patients in the combined group achieved final subjective refraction within ±0.5D (27.6% vs. 46.2%, P=0.01) compared with controls. Within the sequential group, there were no differences in RPE when the fellow eye axial length was used to predict refractive outcome (P=0.17) or between the group with precataract surgery IOPs of ⩽11 mm Hg (−0.28±0.82) and the group with >11 mm Hg (−0.28±0.53, P=0.99). For the sequential group, the use of contact A scan yielded less RPE compared with IOLMaster (P=0.01). Conclusions:Combined approach to trabeculectomy and phacoemulsification resulted in greater myopic RPEs that were expectedly greater than those found in the phacoemulsification group.