Purpose: To verify the advantages of trabeculotomy combined with phacoemulsification, intraocular lens implantation and sinusotomy (PTOS) in eyes with exfoliation glaucoma (XFG) and a coexisting cataract.
Patients and methods: Sixty-six eyes of 62 Japanese XFG patients that received either PTOS, phacotrabeculectomy (PTE) or MMC trabeculectomy (LEC) were followed for up to 36 months at Niigata University Medical and Dental Hospital. The outcomes of postoperative intraocular pressure (IOP) and visual acuity as well as complications were compared among the patients who underwent the three surgical procedures.
Results: The average preoperative IOP in the PTOS cases was 22.4 ± 5.13 mmHg, but decreased to 12.3 ± 2.33 mmHg at 12 months post-surgery and was maintained for up to 36 months. The preoperative IOPs, which were 21.9 ± 4.18 mmHg in the PTE group and 26.6 ± 7.57 mmHg in the LEC group, decreased to 13.3 ± 2.79 mmHg in the PTE group and 12.6 ± 6.00 mmHg in the LEC group at 12 months. There were no statistical differences among the three groups at any time point after 3 months. While the postoperative corrected visual acuities were similar between the PTOS and PTE groups, the average time in which the best postoperative visual acuity was reached was significantly shorter in the PTOS group (1.37 ± 1.74 months) than in the PTE group (4.92 ± 4.36 months).
Conclusions: PTOS can be recommended as an initial glaucoma surgery for XFG eyes with coexisting cataracts, because PTOS is not a filtering surgery, but can obtain similar IOP effects as PTE for XFG eyes.