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Editors Selection IGR 9-4

Surgical Treatment: Angle-Closure Glaucoma and Cataract

Comment by Augusto Azuara Blanco on:

84502 Phacoemulsification Versus Phacotrabeculectomy in Primary Angle-closure Glaucoma With Cataract: Long-Term Clinical Outcomes, Hansapinyo L; Choy BNK; Lai JSM et al., Journal of Glaucoma, 2020; 29: 15-23

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In this study, the authors reviewed the medical records and pooled data from two prospective randomized controlled trials comparing two interventions for patients with PACG and cataract. The difference between trials was the IOP control (or lack of) at baseline.

The original trials reported outcomes after two-year follow-up. These trials, although relatively small, were well-designed and have been helpful to inform clinicians. In brief, combined phacotrabeculectomy with mitomycin C was found to be more effective to reduce IOP and glaucoma treatments than phacoemulsification alone. However, combined surgery was associated with more postoperative complications within five years after surgery.

Studies involving multiple surgeons are more generalizable to the community of glaucoma specialists

This paper reports five-year follow-up in the same cohort of patients. Although the study has some methodological weaknesses (retrospective design, attrition of 1/3 of the cohort) overall the data is useful and important as it confirms the results of the initial trials. The authors suggested that combined surgery may provide additional benefits in patients with advanced glaucoma or those suffering from side effects of glaucoma medications.

The authors mentioned that one of the limitations of the study was that surgeries were performed by different surgeons. I would not agree with this point: studies involving multiple surgeons are more generalizable to the community of glaucoma specialists, and thus I would consider it to be a strength.

Finally, I would like to congratulate the authors for conducting the original trials and reporting this long-term follow-up data. Evidence to inform clinical decisions for patients with angle-closure glaucoma is very much needed and this team is making important contributions.

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