Comparative outcomes of phaco-trabeculectomy versus phaco-tube implantation: a 6-year review

BACKGROUND: Combined cataract and glaucoma surgeries are common in patients diagnosed with both visually significant cataract and uncontrolled intraocular pressure (IOP). Although phacoemulsification with Ahmed glaucoma valve (phaco-AGV) implantation and phacoemulsification with trabeculectomy (phaco-trab) are established surgical options, limited data are available on their long-term comparative outcomes, particularly in large patient cohorts. METHODOLOGY: A retrospective cohort study involving 249 eyes of patients who underwent either phaco-AGV (n = 120) or phaco-trab (n = 129) procedures at a tertiary eye center was conducted. Patients were followed for up to 6 years after surgery. The primary outcome measure was surgical success, defined as an IOP between 6 and 21 mmHg with or without glaucoma medications and without further glaucoma surgery or light perception vision loss. Secondary outcomes included IOP level, number of glaucoma medications, best-corrected visual acuity (BCVA), and postoperative complications. Surgical outcomes were analyzed using Kaplan‒Meier survival curves, and chi‒square and ANOVA tests were used to assess differences between the two groups. RESULTS: At the final follow-up, the cumulative probability of surgical success was slightly greater in the phaco-trab group than in the phaco-AGV group (59.9% vs. 40.1%, P < 0.001). The mean IOP was significantly lower in both groups at the final follow-up than at baseline (p < 0.001), with comparable final IOP levels. The mean number of glaucoma medications was significantly lower in the phaco-trab group than in the phaco-AGV group (p < 0.05). Postoperative complications were more frequent in the phaco-AGV group (32.5%) than in the phaco-trab group (16.3%) (p = 0.003). Visual acuity improvements were comparable between the groups. CONCLUSION: Both the phaco-AGV and phaco-trab procedures effectively reduced IOP and improved visual acuity in patients with coexisting cataract and glaucoma. However, phaco-trab was associated with a lower rate of postoperative complications and required fewer long-term glaucoma medications. These findings suggest that while both procedures are viable options, phaco-trab, compared with phaco-AGV, may offer a more favorable risk‒benefit profile across an extended follow-up.