How a Bleb Responds? Combined Phacoemulsification Versus Combined Manual Sics

Introduction: Cataract and glaucoma can be present and managed simultaneously by combined trabeculectomy with phacoemulsification or manual small incision cataract surgery(SICS)via same site or different site. Though they have different shape and size of incision but they serve same goal of maintaining a functioning bleb. Successful trabeculectomy is always assessed by good maintenance of intraocular pressure(IOP) which directly correlates with bleb morphology and internal tract patency. This study was conducted using these parameters to compare the functioning of bleb in combined trabeculectomy with phacoemulsification and manual SICS.

Material and Methods: 30 patientswho had primary open angle glaucoma(POAG) with cataract of nuclear sclerosis grade 2 to 3 and more than 3 months of post operative combined surgery; were taken for the study. 15 patients of combined phacoemulsification were labelled as group A and 15 patients of combined manual SICS as group B. They were examined for functioning of bleb using applanation tonometeryfor IOP; slit lamp examination for bleb morphology via Wuerzberg classification ( WBCS)and ultrasound biomicroscopy (UBM) for scleral reflectivity and route under the flap.

Results: Bleb morphology showed a diffuse bleb in cases of combined manual SICS and a distinct well demarcated bleb in cases of combined phacoemulsification.IOP control and internal tract patency between the two groups was similar except for 1 case of failed trabeculectomy showing fibrosed route under the scleral flap with raised IOP in combined manual SICS.

Conclusion: Combined trabeculectomy with phaco and manual SICS showed different bleb morphology with diffuse bleb in combined SICS and well distinct raised bleb in combined phacoemulsification . Good control of IOP and internal tract patency was seen in all cases. The shape of incision does not hamper the bleb function.

Keywords: Intraocular pressure; Trabeculectomy; combined surgery; bleb morphology; Functioning bleb; Ultrasound biomicroscopy.