Evaluation of pre-operative and post-operative endothelial cell counts in single-site versus twin-site phacoemulsification trabeculectomy: A Prospective, randomized study

Abstract

Introduction: Phacotrabeculectomy is a combined procedure in which both cataract extraction and glaucoma filtering surgery are performed in the same operative session. The one-site approach consists of both cataract extraction and trabeculectomy occurring through a single scleral incision. The two-site approach begins with cataract surgery, typically through a clear cornea incision, followed by a completely separate trabeculectomy performed superiorly upon completing the cataract procedure. This study looks at IOP changes, vision, loss of endothelial cells and BCVA between single-site and twin- site phacoemulsification -trabeculectomy surgeries, Methods: This prospective, randomized study was conducted between September 2014 to August 2015 with sample size of 80 subjects at National institute of Ophthalmology, Pune. Results: The endothelial cell loss was significantly more in single site surgery when compared to twin site surgery, in both at 1 month and 3 months follow-up time points (P-value<0.001, unpaired t test). BCVA improved by 50.82% in Single Site and 62.97 % in Twin Site when compared to Pre-op Visual Acuity at 3 months post-op time point. Distribution of subjects improved to the desired direction on BCVA in both single site and twin site procedures at both 1 month and 3-month follow-up time points. Conclusion: Phacotrabeculectomy surgery should be considered in patients with required low target IOP, complex medical regimens and advanced glaucoma. In terms of corneal safety twin site surgery has an edge over single site surgery at a follow up period of 3 months.