Background: To stratify the outcomes of phacoemulsification combined with trabectome surgery using a new\nglaucoma severity index.\nMethods: This is a retrospective, observational cohort study that included open angle glaucoma patients with\nvisually significant cataract that had phacoemulsification combined with trabectome surgery. Exclusion criteria were\nfollow-up less than 12 months, any other surgeries or diagnosis of neovascular or active uveitic glaucoma. Patients\nwere stratified into four groups according to the Glaucoma Index (GI) that incorporated preoperative intraocular\npressure (IOP), number of medications and visual field status. The primary outcome measures were IOP reduction\nand the success rate at 12 months. We examined the relationship between GI group and IOP and medications at\none year with a linear regression analysis and survival with log-rank testing.\nResults: Of 1374 patients, a total of 498 cases with 12 month follow-up were included in the study after applying\nthe exclusion criteria. At one year, IOP of GI groups 1 through 4 was reduced by 2.9 �± 4.4, 3.6 �± 5.0, 3.9 �± 5.3, and 9.\n2 �± 7.6 mmHg for. Individuals in the next higher GI group had a 1.69 �± 0.2 mmHg larger IOP decrease. The success\nrate was 98%, 93%, 96% and 88% at one year for GI groups 1 to 4 (p < 0.05).\nConclusions: A substantial IOP reduction was seen in subjects with more advanced glaucoma suggesting that the\ntrabecular meshwork is the primary impediment to outflow and its ablation benefits those eyes relatively more than\nin mild glaucoma. A larger IOP reduction can be expected in individuals with a higher GI group that indicates a\nclinically more challenging glaucoma.
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