Phacotrabeculectomy Has Significantly Lower Failure Rate Than Trabeculectomy

Adding phacoemulsification to trabeculectomy can improve glaucoma surgery success rates.

Phacotrabeculectomy has a significantly lower 2-year failure rate compared with trabeculectomy alone in both patients with primary open angle glaucoma (POAG) and patients with primary angle closure glaucoma (PACG), according to a study published in the Journal of Glaucoma. The effects of combining phacoemulsification with trabeculectomy are comparable between eyes with POAG and PACG, according to the report.  

Researchers retrospectively reviewed 146 eyes of 121 phakic patients (mean age, 62 years; 59% women) with POAG (n=71 eyes) or PACG (n=75 eyes) who underwent primary mitomycin-C (MMC) augmented trabeculectomy, with and without phacoemulsification at a single center between 2009 and 2018. In total, 74 eyes underwent isolated trabeculectomy (Trab) and 72 eyes underwent combined phacotrabeculectomy (Phaco+Trab). The patients in the Phaco+Trab group were significantly older compared with patients in the Trab group (P <.001). 

When defining failure with intraocular pressure (IOP) criteria of greater than 18 mm Hg or IOP reduction of less than 30%, the failure rates were 42% and 62% for Phaco+Trab and Trab, respectively, the report shows. The Phaco+Trab group had a significantly lower failure rate compared with the Trab group for all patients (risk ratio [RR] 0.60, 95% confidence interval [CI] 0.44 to 0.81, P =.001). 

There were no significant differences in the postoperative IOP, percentage of IOP reduction and number of glaucoma medications between the POAG and PACG groups (all P >.05). The effects of combining phacoemulsification with trabeculectomy were similar in the POAG and PACG groups, for each outcome (all P >.05).

Surgical technique, glaucoma subtype, and ethnicity could influence the disparity.

“While our study found that the Phaco+Trab had a lower failure rate than the Trab group in the POAG subgroup, prior studies in open angle glaucoma mostly suggested a comparable or better outcome in trabeculectomy than phacotrabeculectomy. Surgical technique, glaucoma subtype, and ethnicity could influence the disparity,” according to the researchers. “The results showed that both surgeries were effective in achieving IOP reduction.” 

Study limitations include its retrospective nature and the surgeries were performed by different surgeons.  


Winuntamalakul Y, Chansangpetch S, Ratanawongphaibul K, et al. Two-year outcomes of trabeculectomy and phacotrabeculectomy​ in primary open angle versus primary angle closure glaucoma. J Glaucoma. Published online January 3, 2023. doi:10.1097/IJG.0000000000002172.