Outcome of combined trabeculectomy with cataract surgery in patients on prostaglandin analogues and aqueous suppressants

Abstract

Abstract Purpose: To compare the effect of prostaglandin analogues (PGA) against other glaucoma medications (Non-PGA) on the intraocular pressure (IOP) outcomes of combined trabeculectomy with phacoemulsification, and the conjunctival cell profile in persons with primary open-angle (POAG) and pseudoexfoliation glaucoma (PXFG) Methods: Prospective cohort study was conducted among 116 patients with POAG or PXFG on glaucoma medications for a minimum of 3 months undergoing glaucoma triple procedure. Patients were divided into 2 groups (PGA and Non-PGA group) based on preoperative exposure to PGA. IOP outcomes were assessed for up to 2 years. Conjunctival biopsy specimens were obtained at the time of surgery and histopathological analysis was performed. Results: 42 patients were in the PGA group and 67 in the Non-PGA group and 7 were lost to follow-up. Non-PGA group had lesser mean postoperative IOP and needed less postoperative medications compared to the PGA group in all visits up to 2 years. Non-PGA group had better complete success rate (50.7% vs 14.3%, P value <0.001). Kaplan Meier survival estimates showed significant difference in cumulative complete success rate between Non-PGA (67%) and PGA (26%) by 24 months (P value < 0.001). Cox proportional model showed the type of drug to be significantly associated with surgical failure. Histopathological analysis revealed the PGA group had higher numbers for each type of inflammatory cell (except Mast cells) compared to the Non-PGA group. Conclusion: Patients on PGA are likely to have a higher postoperative IOP and may need more medications for IOP control after a glaucoma triple procedure.