Saurabh Mittal,¹ Apoorva Mittal,¹ Rengappa Ramakrishnan^2
1Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, and ²Aravind-Zeiss Center of Excellence for Glaucoma, Tirunelveli, Tamil Nadu, India

Aim: To determine the safety and efficacy of mitomycin-C–augmented manual small-incision cataract surgery combined with trabeculectomy, and to compare the procedure with phacotrabeculectomy.
Methods: In this retrospective review, 55 eyes undergoing mitomycin-C–augmented manual small incision cataract extraction combined with trabeculectomy were compared with 52 eyes undergoing phacotrabeculectomy. Visual acuity, intraocular pressure, and postoperative complications were analysed.
Results: There were no significant differences in age, sex, laterality, glaucoma type, cataract type, preoperative intraocular pressure, and follow-up duration between the 2 groups. After an average 39.8 months (SD, 18.5 months) follow-up, the intraocular pressure decreased from a baseline of 19.9 mm Hg (SD, 7.47 mm Hg) to 13.9 mm Hg (SD, 3.81 mm Hg) in the manual small-incision cataract surgery group and from 18.0 mm Hg (SD, 6.45 mm Hg) to 13.9 mm Hg (SD, 3.54 mm Hg) in the phacotrabeculectomy group (p < 0.05 for both groups). Surgical success in terms of intraocular pressure <21 mm Hg, with or without antiglaucoma medication, at the end of the follow-up period was 89.1% for the manual small-incision cataract surgery group and 92.3% for the phacotrabeculectomy group. Intraocular pressure reduction was significantly better following mitomycin-C–augmented manual small incision cataract extraction combined with trabeculectomy for open angle glaucoma (7.4 mm Hg). Best-corrected visual acuity improved to ≥6/12 in 43 eyes (78.2%) undergoing manual small-incision cataract surgery and in 44 eyes (84.6%) undergoing phacotrabeculectomy (p = 0.357). The incidence of complications was numerically greater in the manual small-incision cataract surgery group but this was not statistically significant (p = 0.32). The most common complication was posterior capsule opacification, in 44.5% of eyes.
Conclusions: Mitomycin-C–augmented manual small-incision cataract extraction combined with trabeculectomy is safe, effective, and of equal efficacy in terms of intraocular pressure reduction, visual rehabilitation, and complications when compared with phacotrabeculectomy.

Key words: Cataract, Cataract extraction, Glaucoma, Phacoemulsification, Trabeculectomy

Asian J Ophthalmol. 2008;10:221-229.