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Editors Selection IGR 20-4

Surgical Treatment ACG: Combined treatment versus trabeculectomy

Comment by Minguang He on:

24032 Combined trabeculectomy and cataract extraction versus trabeculectomy alone in primary angle-closure glaucoma, Tsai HY; Liu CJ; Cheng CY, British Journal of Ophthalmology, 2009; 93: 943-948

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This study by Tsai et al. (1326) compares the long-term (three years) outcomes of trabeculectomy alone versus combined trabeculectomy surgery in primary angle-closure glaucoma cases. The advantage is its long period of follow-up time that allows observations on the long-term IOP control and late complications. The study concludes that these two treatment strategies have comparable outcomes while about half of trabeculectomy alone group requires cataract surgery in three years. This is an important finding as it suggests combined surgery at least as good as trabeculectomy alone in angle-closure cases. However, the results should be interpreted with caution: the data were collected based on retrospective case chart review. Surgeries were performed in a wide spread period of time (from January 1997 to February 2002) although by one surgeon ‐ surgical skills, selection criteria, indications, method of observation may have been changed dramatically in five years. Treatments were not randomly assigned, therefore, the indications for these two types of surgery presumably should be different. Some important information was not available, i.e., number of acute and chronic ACG in the cohort, extension and progression of PAS after treatment. Thus we believe that the studies based on prospective design aiming to compare the efficacy and safety among phaco alone, trab alone and combined surgery in angle-closure glaucoma cases with or without co-existing cataract are the most needed research in this area.

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