Electron Microscopic Evidence of Photoreceptor Outer-segments in the Trabecular Meshwork in a Case of Schwartz-Matsuo Syndrome.

PURPOSE: To describe a case of photoreceptor outer segment glaucoma (Schwartz-Matsuo syndrome) with electron microscopic evidence of photoreceptor outer segments in the trabecular meshwork (TM). DESIGN: This is a clinicopathologic case report. PARTICIPANT: A 48-year-old Filipino man. METHODS: Specimens of aqueous humor and TM in a clinical case of Schwartz-Matsuo syndrome were examined by electron microscopy. MAIN OUTCOME MEASURES: Electron photomicroscopy. RESULTS: Electron microscopy showed evidence of retinal photoreceptor outer-segments in both an aqueous humor and a TM specimen. CONCLUSION: Schwartz-Matsuo syndrome is associated with the presence of photoreceptor outer segments in the TM.

Frequency of unplanned interventions in patients attending for a presumed routine glaucoma follow-up appointment.

OBJECTIVE: To determine the frequency of patient visits in which an unplanned treatment modification was required in chronic patients attending a glaucoma clinic for routine follow-up and to identify the treatment interventions most commonly employed. DESIGN: Prospective, cross-sectional study. PARTICIPANTS: A total of 630 previously stable patients attending a glaucoma clinic for routine follow-up. METHODS: This was a single-centre survey of all eligible patients returning to an academic glaucoma clinic. Data regarding whether patients' visit remained routine or required intervention, which clinical parameter had changed, and any alterations in treatment regimens were studied. RESULTS: The percentage of patients found to require a change in management was 20.79% (131 of 630 patients); 16.9% were found to have a cause for change because of glaucoma, and the remaining 4% required intervention because of a nonglaucomatous condition. The most common parameter that changed treatment was intraocular pressure (43.87%), followed by visual fields (21.29%). The frequency of abnormal parameters varied within each subtype of glaucoma. The frequency of treatment changes among those with primary open-angle glaucoma was 22.58% compared with 16.5% of glaucoma suspects, 14% of ocular hypertensives, 32% of pseudoexfoliative glaucoma, and 50% of normal tension glaucoma patients. The most common intervention (32.84%) was a change in antiglaucoma medications. The next most frequent interventions were laser procedures (21.90%) and surgery (16.06%). CONCLUSIONS: This study suggests that a significant minority of patients attending a glaucoma clinic for a routine appointment require treatment modification.

Ocular surface toxicity from glaucoma topical medications and associated preservatives such as benzalkonium chloride (BAK).

INTRODUCTION: This review discusses the evidence concerning the effect of topical medications and their preservatives on the ocular surface in glaucoma patients. The role of topical anti-glaucoma medication remains critical in the management of chronic glaucoma worldwide but the beneficial effects of treatment are counterbalanced by the adverse effects of corneal and conjunctival toxicity. Areas covered: This article covers the effect of topical ocular drops and preservatives, particularly benzalkonium chloride, on the cornea and conjunctiva. Both basic science and clinical evidence will be presented. The first part reviews the relationship between ocular surface disease and benzalkonium chloride and the evidence from non-benzalkonium chloride preserved drops. The second part discusses the effects of benzalkonium chloride on the histopathology of the conjunctiva and its impact on clinical care as well as quality of life. Expert opinion: Topical anti-glaucoma medication will continue to be used in the management of this blinding disease for the foreseeable future. Treatment outcomes will benefit from minimized exposure to benzalkonium chloride. The development of alternative preservatives, preservative-free topical options, and non-drop therapeutics such as drug-eluting systems for the delivery of ocular medications, will be very helpful in the care of glaucoma patients.

Prostaglandin agonist effect on matrix metalloproteinase aqueous levels in glaucoma patients.

OBJECTIVE: To determine whether the aqueous levels of matrix metalloproteinases (MMPs) differ between patients with glaucoma treated with topical prostaglandin analogues and normal, nonglaucomatous control patients. Also, to note any difference in MMP levels between latanoprost, travoprost, and bimatoprost that might suggest a difference in efficacy or mechanism of action between these drugs. DESIGN: Prospective, observational study. PARTICIPANTS: Patients who were scheduled to undergo routine intraocular surgery (phacoemulsification or combined phacotrabeculectomy) as part of their standard clinical care were included. Eighteen eyes of 18 patients with glaucoma using any 1 prostaglandin analogue (latanoprost, travoprost, or bimatoprost) were compared with 8 normal control patients. METHODS: This was a multicentre study. Aqueous humour (0.2 mL) was aspirated at the beginning of the intraocular surgery through a clear corneal paracentesis. MMP-2 and -9 were quantified in the aqueous of all participants using enzyme-linked immunosorbent assay. RESULTS: There was no significant difference in the levels of either MMP-2 (p = 0.216) or MMP-9 (p = 0.552) between the control patients and the patients with glaucoma on prostaglandins. There was no difference in the levels of MMP-2 or -9 between the latanoprost, travoprost, or bimatoprost groups. CONCLUSIONS: The levels of MMP-2 and -9 in aqueous of glaucomatous eyes on topical prostaglandin analogues were the same as those of normal age-matched control patients. This could reflect either a return to normal levels with efficacious treatment or a lack of difference between disease and nondisease states.

A randomized clinical trial of selective laser trabeculoplasty versus argon laser trabeculoplasty in patients with pseudoexfoliation.

PURPOSE: To evaluate the efficacy of selective laser trabeculoplasty (SLT) versus argon laser trabeculoplasty (ALT) in lowering the intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension secondary to pseudoexfoliation. DESIGN: Multicentered randomized clinical trial. PARTICIPANTS: A total of 76 eyes from 60 patients with pseudoexfoliation and uncontrolled IOP were recruited from 5 Canadian academic institutions. Patients with prior laser trabeculoplasty, ocular surgery within 6 months, previous glaucoma surgery, an advanced visual field defect, current steroid use, and monocular patients were excluded. METHODS: Eyes were randomized to receive either 180-degree SLT or 180-degree ALT by a nonblocked randomization schedule stratified by center. MAIN OUTCOME MEASUREMENT: The primary outcome was the change in IOP at 6 months versus baseline and secondary outcomes included change in number of glaucoma medications after laser. Baseline variables included age, sex, angle grade, angle pigmentation, and number of glaucoma medications. RESULTS: Of the 76 eyes, 45 eyes received SLT and 31 eyes received ALT. The overall age was 72.9 years (65% females). The baseline IOPs in the SLT and ALT groups were 23.1 and 25.2 mm Hg, respectively (P=0.03). The IOP reduction 6 months after SLT was -6.8 mm Hg and post-ALT was -7.7 mm Hg (P>0.05). The SLT group had reduced glaucoma medications by 0.16 medications at 6 months and the ALT group had no decrease in medications over the same time period (P=0.59). There were no postlaser IOP spikes in either group. DISCUSSION: ALT and SLT are equivalent in lowering IOP at 6 months posttreatment in patients with PXF.

Preservative exposure and surgical outcomes in glaucoma patients: The PESO study.

PURPOSE: To study the impact of benzalkonium chloride (BAK) exposure from eye drops on subsequent time to trabeculectomy failure. PATIENTS AND METHODS: Retrospective chart review of 128 glaucoma patients who had undergone a trabeculectomy between 2004 and 2006. The number and type of ophthalmic drops used preoperatively and relevant demographics were recorded. Surgical failure criteria included inadequate pressure lowering or need for postoperative ocular antihypertensives, laser trabeculoplasty, 5-fluorouracil needling, or repeated surgery. Patients were examined for these criteria over a minimum postoperative period of 2 years. Data were assessed using Kaplan-Meier and Cox regression models. RESULTS: Complete surgical success was achieved in 47.7% of patients. Patients received between 1 and 8 BAK-containing drops daily, with a median of 3. Time to surgical failure in patients receiving higher preoperative daily doses of BAK was shorter than in patients who had less BAK exposure (P=0.008). Proportional hazard modeling identified uveitic and neovascular glaucoma as significant confounders of the univariate model (P=0.024), although the main effect of BAK exposure was maintained with a hazard ratio of 1.21 (P=0.032). The number of different medications used to control intraocular pressure did not significantly affect survival time in a secondary Cox model (P=0.948). CONCLUSIONS: Increased preoperative exposure to ophthalmic solutions preserved with BAK is a risk factor for earlier surgical failure, independent of the number of medications used. This study extends earlier findings of potential adverse effects of ophthalmic preservatives on surgical outcomes to the modern pharmacopeia used in the medical management of glaucoma.

Relationship between central corneal thickness and progression of visual field loss in patients with open-angle glaucoma.

OBJECTIVE: To determine whether a relationship exists between central corneal thickness (CCT) and visual field (VF) progression in treated patients with open-angle glaucoma and asymmetric corneal thickness. DESIGN: Retrospective chart review. PARTICIPANTS: We studied 100 charts of patients with open-angle glaucoma and also bilateral CCT and VF data. METHODS: Charts from 2 glaucoma subspecialty practices were reviewed. The CCT and the rate of progression and event analysis of visual field data were assessed in all subjects. Subanalysis was performed for subjects whose CCT asymmetry was ≥ 16 µm. RESULTS: The mean CCT was 544 ± 40 µm OD and 541 ± 40 µm OS. The mean CCT difference between fellow eyes was 15 ± 11 µm (range, 1 to 52 µm). There was no significant intrasubject difference in the mean deviation (MD) and the pattern standard deviation (PSD) (p =0.917 and p = 0.704, respectively; paired t test). The more advanced VF MDs and PSDs were found in the thin eyes of 47 and 50 subjects, respectively (p = 0.459 and p = 0.317, respectively; χ(2)). Of the 65 subjects whose visual field indexes were available, 34 had the more rapid visual field index rates of progression in the thin eye (p = 0.400; χ(2)). Of the 27 subjects for whom event analysis was available, 15 had the worse progression category in the thin eye (p = 0.453, χ2). Subgroup analysis of 48 subjects with ≥ 16 µm CCT asymmetry did not find any significant difference in analyses of field progression between fellow eyes. CONCLUSIONS: No relationship was found between CCT and VF loss in treated patients with primary open-angle glaucoma or normal-tension glaucoma with asymmetrical CCT. Specifically, the thin eye did not have the more advanced VF loss or more rapid VF progression.

The influence of central corneal thickness on response to topical prostaglandin analogue therapy.

OBJECTIVE: Central corneal thickness (CCT) affects intraocular pressure (IOP) readings; however, CCT influence on topical medication efficacy is unknown. We evaluated the IOP-lowering effect of topical prostaglandin analogues (PGAs) in relation to CCT. DESIGN: Post hoc analysis of a randomized prospective trial. METHOD: Subjects randomized to a PGA were followed for 24 weeks and were analyzed for relationship between CCT and IOP lowering. PARTICIPANTS: Patients with either newly diagnosed ocular hypertension or open-angle glaucoma. RESULTS: 75 subjects were enrolled. The mean age was 62.7 ± 10.5 years; 48 were Caucasian. The mean CCT was 562.4 ± 41.4 µ. At repeated measures, ANCOVA analysis showed a significant effect of both baseline IOP (p < 0.0001) and CCT (p = 0.003) on IOP. At week 12, a regression analysis of the effect of CCT on baseline IOP showed that for every 10 µ increase in CCT there was 0.3 mm Hg less IOP decrease from baseline. CONCLUSIONS: We found a statistically significantly association between a lower mean IOP and a thinner cornea when baseline IOP is controlled for. The magnitude of the relationship is small but may be clinically significant in patients with either very thin or very thick corneas.

Five-year results of 5-fluorouracil augmented needling revision of failing blebs.

BACKGROUND AND OBJECTIVE: To report the 5-year intraocular pressure (IOP) outcomes of patients requiring a 5-fluorouracil (5-FU) needling revision compared to a matched sample. PATIENTS AND METHODS: Forty eyes receiving 5-FU bleb needling revision were matched to 40 patients not needled. IOP was recorded preoperatively and annually to 5 years. The main outcome measure was surgical success: IOP control without medications or surgery. RESULTS: Thirty-two patients with 5-FU needling revision (80.0%) required anti-glaucoma medication postoperatively versus 28 control patients (70%) (P > .05). Thirty-two patients with 5-FU needling revision were complete or qualified successes compared to 36 control patients (P = .34). Eight patients with 5-FU needling revision (20%) had a reoperation versus 4 control patients (10%) (P > .05). CONCLUSION: 5-FU needling revision can produce long-term IOP control levels similar to those who did not require the procedure. No statistically significant differences between the two groups was seen in either the use of medications or further surgery.

Argon versus selective laser trabeculoplasty in younger patients: 2-year results.

OBJECTIVE: To compare the effectiveness of argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT) in lowering intraocular pressure (IOP) in younger patients (age 60 or less). METHODS: This was a prospective randomized control trial. Forty-two young patients (age 29 to 60 y) had 1 eye randomized to ALT (n=22) or SLT (n=20). IOP was measured before laser and 1 hour, 1 day, 6 weeks, 3 months, every 3 months until 2 years, and then yearly postlaser. Chi-square analysis and Student t test were used to determine statistical significance. RESULTS: The mean IOP before treatment was 21.9 mm Hg for ALT and 19.1 mm Hg for SLT with no statistical difference between the groups (P>0.05). At 2 years, 86.4% of ALT and 75.0% of SLT eyes required no further surgical intervention (laser trabeculoplasty or trabeculectomy). During the same time period, there was a statistically significant IOP decrease of 11.1% after ALT (P=0.01) and 7.7% after SLT (P=0.01) with no statistical difference between the lasers (P>0.05). CONCLUSIONS: In younger patients, both ALT and SLT have a significant ocular hypotensive effect 2 years after treatment, with no differences in outcome identified between the laser modalities.

Comparison of newly diagnosed ocular hypertension and open-angle glaucoma: ocular variables, risk factors, and disease severity.

Purpose. To describe the distribution of ocular variables, risk factors, and disease severity in newly diagnosed ocular hypertension (OH) or open-angle glaucoma (OAG). Methods. Eligible subjects underwent a complete history and examination. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) obtained from multiple logistic regression models were used to compare OAG to OH and advanced to early/moderate OAG. Results. 405 subjects were enrolled: 292 (72.1%) with OAG and 113 (27.9%) with OH. 51.7% had early, 27.1% moderate, and 20.9% advanced OAG. The OR for OAG versus OH was 8.19 (P < 0.0001) for disc notch, 5.36 (P < 0.0001) for abnormal visual field, 1.45 (P = 0.001) for worsening mean deviation, 1.91 (P < 0.0001) for increased cupping, 1.03 for increased age (P = 0.030), and 0.36 (P = 0.010) for smoking. Conclusions. Increased age was a risk for OAG, and smoking decreased the risk of OAG compared to OH. Almost half of the OAG subjects had moderate/advanced disease at diagnosis.

Prostaglandin efficacy and safety study undertaken by race (the PRESSURE study).

PURPOSE: Latanoprost, travoprost, and bimatoprost are prostaglandin or prostamide-type ocular hypotensive medications, all of which are effective and safe for lowering intraocular pressure (IOP). Most studies with these types of drugs have included patients mainly from European or white ethnic backgrounds; however, some reports have suggested that there is a difference in response between patients of white and African racial heritage. On account of the possibility that drugs may act differently in people of different ethnic background, we decided to study the effectiveness and safety of all 3 drugs in people from various ethnic heritages. Our hypothesis was that there might be a possible ethnic-based difference in IOP-lowering effectiveness between the 3 medications. METHOD: This was a prospective randomized investigator-masked multicenter study. Patients newly diagnosed with open-angle glaucoma (primary, pseudoexfoliative, or pigmentary), or whose pressure became elevated after a washout period, were randomized to receive 1 of 3 prostaglandin/prostamide drugs. Assignment of drug was balanced by racial group and study site, and the investigator was masked to the drug used. The patients were requested to self-identify their racial group as White, African, East Indian, Asian, or Hispanic; to minimize the possibility of heterogeneity, all 4 grandparents had to be known to originate from the same group. However, for purposes of analysis, the patients were divided into 2 groups--White or Other. Patients were followed at 2, 6, 12, and 24 weeks; IOP and local side effects were assessed at each visit. RESULTS: Eighty-three patients were recruited from 9 sites. The mean age of the patients was 61.5 ± 10.5 years. There were no differences in mean age or the distribution of sex between the patients whether examined by the 2 racial groups or the 3 drug groups. There was a highly statistically significant decrease in IOP from baseline to 12 weeks and from baseline to 24 weeks (F = 439.3, P<0.0001; F = 305.94, P<0.0001). There were no differences in treatment effect between the 3 drugs or between the 2 ethnic groups, (P > 0.05 for all comparisons) and there was no interaction between race and drug. CONCLUSIONS: All 3 prostaglandin/amide drugs are highly effective at lowering IOP. No differences in effect between the drugs or between members of different racial groups were detected, although the study sample size was too small to be certain to detect differences, if they existed.

The efficacy of 5-fluorouracil bleb needling performed 1 year or more posttrabeculectomy: a retrospective study.

PURPOSE: To determine the efficacy of a subconjunctival needling revision using 5-fluorouracil (5FU) when administered to patients who have nonfiltering, flat, or encapsulated blebs over 1 year after the original surgery. METHODS: The charts of 37 glaucoma patients, who had undergone both a trabeculectomy filtering procedure and a subconjunctival 5FU needling revision, with a minimum interval of 1 year between these procedures and with no intervening surgical procedures, were retrospectively reviewed. The needling was a clinic procedure using a 30-gauge needle and 0.1 mL of 50 mg/mL 5FU. RESULTS: Intraocular pressure (IOP) decreased by an average of 10.5 mm Hg (44.8%) immediately after the needling procedure. Eleven eyes (29.7%) achieved absolute success, defined as IOP control with no further needling revision, surgical intervention, or antiglaucoma medication in the 2-year follow-up period. Thirteen eyes (35.1%) achieved a qualified success, defined as IOP control with resumed medication use, undergoing a laser procedure, or a repeat needling within the follow-up period. Thirteen eyes (35.1%) failed the procedure by requiring a repeat surgical intervention. The mean IOP was 16.3+/-4.6 mm Hg in the success group, 15.5+/-6.5 mm Hg in the qualified success group, and 27.7+/-8.9 mm Hg in the failure group at the end of follow-up. CONCLUSIONS: Late 5FU needling is an effective method to control IOP and avoid further surgery in a high proportion of patients with medically uncontrolled nonfiltering blebs.

Selective laser trabeculoplasty retreatment after prior argon laser trabeculoplasty: 1-year results.

BACKGROUND: Argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT) are treatments for open-angle glaucoma. Many patients have previously received ALT but could benefit from further treatment. The purpose of this study was to examine whether SLT provided clinical benefit for patients who had previously received complete argon treatment. METHODS: This was a prospective, partially randomized, comparison study. The study compared the effect after 1 year of SLT in patients with open-angle glaucoma (primary, pigmentary, or pseudoexfoliation) who had previously received 360 degrees of ALT with the effect of laser treatment (ALT or SLT) given for the first time in patients with this condition. Ninety-six subjects were given 180 degrees of laser trabeculoplasty. When both eyes qualified for treatment, the first eye treated was included in the analysis. Twenty-seven subjects were treated with SLT after previously receiving 360 degrees of ALT therapy; the remainder were given their first laser treatment, 30 being randomly assigned by coin toss to receive SLT and 39 to receive ALT. RESULTS: The mean intraocular pressure (IOP) before treatment was 21.5 mm Hg (SLT after ALT), 22.9 mm Hg (SLT), and 22.0 mm Hg (ALT), with no statistical difference among the groups (p > 0.05). The mean IOP at 1 year was 16.7 mm Hg (SLT after ALT), 17.1 mm Hg (SLT), and 16.4 mm Hg (ALT). The IOP for all 3 groups was statistically significantly lower than at baseline (p < 0.001), but there were no differences among the groups in this respect (p > 0.05). At 1 year, the percentage IOP reductions from baseline were 23% (SLT), 19.3% (SLT after ALT), and 24% (ALT). There were no differences among the groups in the number of medications used before the laser, although there was a small but statistically significant decrease in the number of medications used before or after the laser treatment in both the SLT and the SLT after ALT group, but not the ALT group. INTERPRETATION: SLT retreatment can produce a clinically useful decrease in IOP at 1 year, similar to that obtained by ALT, in patients who have had prior argon laser treatment. SLT may be a useful adjunctive therapy when 360 degrees of ALT has already been performed.

Intraocular pressure spike after YAG iridotomy in patients with pigment dispersion.

BACKGROUND: The role of laser peripheral iridotomy to break a suspected reverse pupil block in the long-term control of pigment dispersion is promising, but the usefulness of this procedure has not been completely established. The author examined whether patients with pigment dispersion are at higher risk for an intraocular pressure (IOP) spike after laser peripheral iridotomy due to possible compromise of trabecular meshwork function, compared with patients undergoing prophylactic peripheral iridotomy for an occludable angle. METHODS: Data were collected prospectively on the first eye of 87 patients with occludable angles and 13 patients with pigment dispersion treated with peripheral laser iridotomy between November 1995 and October 1996 at the glaucoma service of a university-affiliated hospital in Toronto. All patients received one drop of 0.5% apraclonidine before the procedure. IOP was measured before and 1 and 24 hours after the procedure. RESULTS: There was no difference between the two groups in the distribution of right vs. left eyes, sex, race, the mean total energy required to produce a patent iridotomy, the mean number of medications used or the mean IOP before the procedure. The patients with pigment dispersion were significantly younger than those with occludable angles (mean age [and standard deviation (SD)] 40.5 [9.45] years vs. 66.4 [10.78] years) (p < 0.001). There was no difference between the two groups in mean IOP at 1 hour or at 24 hours. Twenty-nine patients (33%) in the occludable angle group and seven (54%) in the pigment dispersion group had an IOP spike greater than 2 mm Hg after the procedure (p = 0.001). Among these patients, the mean IOP (36.4 [SD 10.83] mm Hg vs. 30.3 [SD 7.04] mm Hg, p = 0.05) and the mean rise in IOP (14.0 [SD 10.63] mm Hg vs. 8.7 [SD 4.73] mm Hg, p = 0.04) were significantly higher in those with pigment dispersion than in those with occludable angles. Among the patients who used antiglaucoma medications before the procedure or had a prelaser IOP level greater than 22 mm Hg, those with pigment dispersion were more likely than those with occludable angles to have an IOP spike at 1 hour (p < or = 0.005). INTERPRETATION: Patients with pigment dispersion undergoing iridotomy to break a reverse pupil block should be carefully assessed after the procedure, as significant pressure spikes requiring treatment may occur.

The use of topical ketorolac 0.5% for pain relief following cyclophotocoagulation.

BACKGROUND AND OBJECTIVE: Laser cycloablation is frequently used for glaucoma palliation. Although usually successful, the procedure is often accompanied by pain. The purpose of this prospective, randomized study was to study topical ketorolac for the amelioration of pain following cycloablation. PATIENTS AND METHODS: Thirty-six patients requiring a cyclodestructive procedure were randomized into two groups. Each group received a standardized cycloablative laser procedure and routine postoperative drops. Patients were randomized to receive additional topical ketorolac or not. Patients indicated by a mark on a standardized 100-mm line their subjective experience of pain. RESULTS: There were no differences between the patient groups regarding preoperative demographic factors. There was a significant difference between the groups in the average and daily pain rating, with the ketorolac therapy group reporting significantly less pain. CONCLUSION: The addition of topical ketorolac significantly lessened the pain reported by patients following a cyclodestructive laser procedure.

The effect of blindness on horizontal plane sound source identification.

The effect of blindness on sound source identification was studied. Four groups of normally-hearing adults, two sighted and two blind, participated. Subjects were tested using arrays of four and eight loudspeakers, surrounding them in the horizontal plane. One sighted group was tested in quiet. The other groups were tested in continuous 60-dB SPL white noise. Three 75-dB SPL 300-ms stimuli were localized: one-third octave noise bands, centered at 0.5 and 4 kHz, and broadband noise. Broadband noise was easiest to localize (both binaural and spectral cues available), and the 0.5-kHz noise band was the most difficult (primarily interaural temporal difference cue available). Subjects with late-onset blindness achieved significantly higher scores than the early blind and blindfolded sighted subjects. The percentage correct decreased with an increase in the number of speakers, but background noise had no effect. The results attest to the benefit of early visual experience for spatial hearing in adulthood, and demonstrate the negative impact of sudden loss of sight.

Comparison of long-term incidence of posterior capsular opacification between phacoemulsification and phacotrabeculectomy.

PURPOSE: To investigate the long-term incidence of posterior capsular opacification after phacoemulsification compared with phacotrabeculectomy with or without adjunctive subconjunctival mitomycin C. METHODS: This was a retrospectively conducted long-term, observational, case-control study. One hundred eyes of 100 cataract patients who underwent phacoemulsification and posterior chamber intraocular lens implantation and 100 eyes of 100 primary open-angle glaucoma patients with cataract that underwent phacotrabeculectomy and posterior chamber intraocular lens implantation, matched with respect to age, intraocular lens type, prevalence of diabetes mellitus, and length of follow-up. The main outcome measure was the rate of clinically significant posterior capsular opacification as determined by slit-lamp biomicroscopy and necessity to perform neodynium:yttrium aluminum garnet (Nd:YAG) capsulotomy and as calculated by Kaplan-Meier survival analysis. Postoperative visual acuity and maintenance of intraocular pressure control were also measured. RESULTS: There was no significant difference in the rate of posterior capsular opacification requiring Nd:YAG capsulotomy between the phacoemulsification and phacotrabeculectomy groups (P =.77). However, a significant difference in the rate of posterior capsular opacification was found between those patients without diabetes mellitus and those with a preoperative diagnosis of diabetes mellitus (P =.016). Also, survival analysis comparing use of mitomycin C with no use of mitomycin C in the phacotrabeculectomy group showed a higher survival in the mitomycin C subgroup (P =.03). CONCLUSION: There was no significant difference in long-term posterior capsular opacification between phacoemulsification and phacotrabeculectomy in the study population. Intraoperative, adjunctive use of mitomycin C in the phacotrabeculectomy group and the presence of diabetes mellitus in the overall patients were beneficial (protective) factors against posterior capsular opacification.