Comparison of Phacotrabeculectomy and Trabeculectomy in the Treatment of Primary Angle-closure Glaucoma (PACG)
Condition: Glaucoma, Angle-Closure; Cataract
MeSH terms: Glaucoma; Cataract; Glaucoma, Angle-Closure
Study type: Interventional

Summary: 
      Primary angle closure glaucoma (PACG) is caused by contact between the iris and trabecular
      meshwork, which in turn obstructs outflow of the aqueous humor from the eye. This contact
      between iris and trabecular meshwork (TM) may gradually damage the function of the meshwork
      until it fails to keep pace with aqueous production, and the pressure rises, and at last the
      optic nerve is damaged, the vision may be lost in some severe cases. Therefore, ocular
      pressure reduction is the key to treat the disease and prevent blindness. Trabeculectomy is
      the most common conventional surgery performed for glaucoma. This allows fluid to flow out of
      the eye through this opening, resulting in lowered intraocular pressure(IOP) and the
      formation of a bleb or fluid bubble on the surface of the eye.

      Cataract surgery is common in the elderly. Cataract surgery is the removal of the natural
      lens of the eye (also called "crystalline lens") that has developed an opacification, which
      is referred to as a cataract. Cataract extraction includes intracapsular cataract extraction,
      extra capsular cataract extraction & phacoemulsification, and phacoemulsification is the
      preferred method. It has been reported that IOP reduction could occur in cataract patients
      with PACG after the cataract surgery. For some cases with PACG, such IOP reduction may be
      insufficient for neuronal protection, and many patients still require glaucoma medication and
      incisional surgery such as trabeculectomy to control IOP. In such cases, a combined
      cataract-glaucoma procedure (phacotrabeculectomy) is a reasonable option. In keeping with
      this concept, previous studies have shown that phacotrabeculectomy could effectively and
      simultaneously reduce IOP and improve vision in patients with a coexistence of PACG and
      vision-threatening cataract. However, phacotrabeculectomy may heighten inflammatory response,
      result in a higher frequency of postoperative complications such as hyphema and fibrin in the
      anterior chamber, endophthalmitis, and increased scarring of the filtering bleb. Thus, it is
      unclear whether phacotrabeculectomy is as effective and safe as trabeculectomy in lowering
      IOP for PACG patients.

      In the present study, the investigators compared the efficacy and safety of
      phacotrabeculectomy and trabeculectomy in patients with coexisting PACG and cataract.
    


Intervention name(s): combined phacotrabeculectomy; trabeculectomy
Intervention type(s): Procedure; Procedure
Intervention description(s): trabeculectomy plus phacoemulsification with intraocular lens implantation
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Primary angle-closure glaucoma; cataract; trabeculectomy; phacotrabeculectomy