Combined cataract and glaucoma surgery: the effect of pupil enlargement on surgical outcomes (an American Ophthalmological Society thesis).

PURPOSE To determine whether pupil enlargement during phacotrabeculectomy affects postoperative visual acuity and intraocular pressure (IOP) compared to combined surgery without pupil enlargement. METHODS A retrospective study of 74 patients who underwent combined phacotrabeculectomy with (37 eyes) or without (37 eyes) pupil enlargement was performed. Postoperative outcome measures included best-corrected visual acuity (BCVA), IOP, number of medications, and complications up to 6 months. Wilcoxon-Mann-Whitney test was used to compare outcomes between groups. RESULTS Demographic characteristics of the two groups were similar except for diagnosis; chronic angle-closure glaucoma and pseudoexfoliation syndrome were more common in the pupil enlargement group. Preoperatively, the pupil enlargement group had a mean IOP of 21.2 ± 6.6 mm Hg compared to 21.1 ± 6.4 mm Hg for the control group (P=.978, Wilcoxon-Mann-Whitney test). Mean preoperative logMAR equivalent (BCVA) was 0.68 ± 0.67 and 0.63 ± 0.59, respectively (P=.727, Wilcoxon-Mann-Whitney test). At 6 months, mean IOP was 15.5 ± 5.6 mm Hg in the study group and 13.3 ± 4.5 mm Hg in the control group (P=.039, Wilcoxon-Mann-Whitney test). Mean postoperative vision at 6 months was better in the control group (0.36 ± 0.48) vs pupil enlargement group (0.51 ± 0.66) but not statistically different (P=.324 Wilcoxon-Mann-Whitney test). The groups did not differ in number of postoperative glaucoma medications. Complications were rare in both groups. CONCLUSION The results of this study suggest that the outcomes of combined phacoemulsification and trabeculectomy are not adversely impacted by pupil enlargement, although IOP control may be relatively impaired.