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Editors Selection IGR 18-3

Surgical treatment: One – versus two-site phacotrabeculectomy

Comment by Norbert Pfeiffer on:

20813 Randomized comparison of 1-Site and 2-Site phacotrabeculectomy with 3-year follow-up, Cotran PR; Roh S; McGwin G, Ophthalmology, 2008; 115: 447-454

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A glaucoma patient in need of glau-coma surgery often has a cataract necessitating surgery at the same time. Previous studies suggested that a two site approach might be superior to a one-site approach. Cotran et al. (434) laudably rechallenged this by performing a randomized prospective study with a three year follow-up comparing a one-site phaco-trabeculectomy with a fornix-based flap to a two-site phaco-trabeculectomy with a limbus-based flap for the trabeculectomy and a corneal approach for the cataract. There were no statistically significant differences for IOP or need of postoperative medications between both groups. However, there were more conjunctival leaks in the fornix-based group while the duration of the operation was longer for the two-site approach. The authors used the two different approaches because these reflected their normal procedures for phaco-trabeculectomy (fornix-based) and for trabeculectomy alone (limbus-based). The authors conclude that both techniques produce similar results. Most likely this is true. However, in the two-site group far more patients had IOPs < 13 (21 vs 14) or < 18 mmHg (29 vs 27) without receiving medications. Also, the study shows a general problem in surgical studies: Before the study the surgeons had used either one-site phaco-trabeculectomy (fornix-based) or trabeculectomy alone (limbus-based). So the two-site phaco-trabeculectomy was the newer method to them. Still, there was a tendency for better results in this group. A much larger number of eyes might have shown a better outcome, in line with the previous studies. Thus, we will need more clinical studies.

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