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.