Background: Combined phacoemulsification, intraocular lens implantation, and trabeculectomy (PTE) is currently the standard procedure for most ophthalmic surgeons to treat uncontrolled open-angle glaucoma and cataract at one time. This study was designed to prospectively compare a new technique of phaco-trabeculotomy plus deep sclerectomy (PDSTO) with standard phaco-trabeculectomy (PTE).

Methods: A consecutive series of 43 patients with uncontrolled open-angle glaucoma and cataract underwent combined glaucoma and cataract surgery. The procedure started as a two-site approach with phacoemulsification and IOL implantation through a temporal incision in clear cornea. Trabeculotomy and deep sclerectomy were performed in the superior quadrant. Trabeculectomy was also performed in the superior quadrant as a modified Cairns trabeculectomy. Postoperatively, examinations were performed on a daily base for 1 week. Follow-up visits were applied 1, 3, 6, and 12 months after surgery.

Results: The mean preoperative intraocular pressure (IOP) was 26.5 mmHg (SD 7.8) for all patients enrolled. The mean IOP was 12.3 mmHg (SD 5.1) 1 day post surgery for the PTE group (p < 0.001) and 14.4 mmHg (SD 4.0) for the PDSTO group (p < 0.001). At 12 months post surgery the success rate according to the Advanced Glaucoma Intervention Study (AGIS), defined as an IOP lower than 18mmHg without medication, was 20% in the PTE group and 50% in the PDSTO group (p = 0.03). The number of postoperative complications was equally low for both groups. No severe complications, such as bleb infection, endophthalmitis, or choroidal hemorrhage were seen in this series.

Conclusions: PDSTO offered significant IOP reduction and a success rate which was higher than that of the current standard, PTE. The specific intra- and postoperative complications of deep sclerectomy, trabeculotomy, and trabeculectomy were seen in our series, although the overall rate of postoperative complications proved low.