Combined Glaucoma and Cataract Surgery: Comparison of Viscocanalostomy, Endocyclophotocoagulation, and Ab Interno Trabeculectomy Publisher Pubmed



Moghimi S^{1, 2} ; Hamzeh N^{1, 2} ; Mohammadi M^{1, 2} ; Khatibi N^{1, 2} ; Bowd C^{1, 2} ; Weinreb RN^{1, 2}
Source: Journal of Cataract and Refractive Surgery Published:2018

Abstract

Purpose: To compare outcomes of phacoemulsification combined with viscocanalostomy, endocyclophotocoagulation (ECP), or ab interno trabulectomy for intraocular pressure (IOP) control and safety in eyes with open-angle glaucoma and visually significant cataract. Setting: Farabi Eye Hospital, Tehran, Iran. Design: Retrospective case series. Methods: Medical records of patients who had combined surgery and were followed for at least 1 year were reviewed. Complete success, postoperative IOP, number of medications at each visit, and complications were evaluated and compared before and after adjustments for confounders. Results: Forty-six eyes had combined phacoviscocanalostomy, 35 had phaco–ECP, and 28 eyes phaco–ab interno trabulectomy. The groups were matched for baseline IOP (P =.24). At the final follow-up (mean 17.2 months ± 5.5 [SD]), the phacoviscocanalostomy group had the lowest mean IOP (13.5 ± 4.7 mm Hg, 29% decrease) (P =.01). There was no significant difference in the final IOP between phaco–ECP and phaco–ab interno trabulectomy (16.4 ± 3.9 mm Hg, 20% decrease versus 15.8 ± 4.2 mm Hg, 15% decrease) (P =.88). The reduction in the number of medications was greater with phacoviscocanalostomy (77%) than with phaco–ECP (40%) and phaco–ab interno trabulectomy (44%) (P =.01). Phacoemulsification–ab interno trabulectomy had the fewest complications. Intraocular pressure spikes were more frequent in the phaco–ECP group (20%) than in the other groups (4%) (P =.05). Conclusions: All procedures significantly lowered IOP. Phacoemulsification–ab interno trabulectomy resulted in fewest complications and phacoviscocanalostomy led to the largest IOP drop and largest reduction of medications. © 2018 ASCRS and ESCRS