Comparative study of endothelial cell loss in trabeculectomy with combined small incision cataract surgery (SICS), trabeculectomy procedure and temporal small incision cataract surgery (SICS) alone

When a patient suffers from co-existing cataract and glaucoma, the choice of surgery may be a combined procedure of cataract extraction and trabeculectomy as a one-stage procedure, or trabeculectomy first to restore visual rehabilitation and to prevent progressive optic nerve damage. The main purpose of this study was to evaluate the endothelial cell loss in trabeculectomy with small incision cataract surgery (SICS) against trabeculectomy and SICS alone. Materials and Methods: This study was conducted on 90 eyes divided into 3 groups among whom 30 cases underwent trabeculectomy through a superior incision, 30 cases underwent SICS with PC-IOL implantation with trabeculectomy through a common superior incision and 30 patients underwent manual SICS with PCIOL. The corneal endothelial cell count and loss was assessed on first postoperative day, 1st week, 1st month and at 3 months. IOP was assessed on postoperative 1st week, 1st month and at 3 months. Results: The endothelial cell loss was more in combined SICS with trabeculectomy group than trabeculectomy group alone. Conclusion: Preoperative evaluation of endothelial cell count must be considered and adequate intra-operative and postoperative measures should be taken to avoid cell loss. However, to avoid further endothelial cell loss due to a two staged surgery, a combined procedure would be a better choice. Combined SICS with trabeculectomy would also reduce the economical burden, postoperative morbidity and the visits of patient to operation theatre.