Efficacy of combined cataract extraction and endoscopic cyclophotocoagulation for the reduction of intraocular pressure and medication burden

AIM： To report on the efficacy of combined endoscopic cyclophotocoagulation（ECP） and phacoemulsification cataract extraction（PCE） with intraocular lens placement for reduction of intraocular pressure（IOP） and medication burden in glaucoma.·METHODS： A retrospective case review of 91 eyes（73patients） with glaucoma and cataract that underwent combined PCE/ECP surgery was performed. Baseline demographic and ocular characteristics were recorded,as well as intraocular pressure, number of glaucoma medications, and visual acuity postoperatively with 12-month follow-up. Treatment failure was defined as less than 20% reduction in IOP from baseline on two consecutive visits（at 1, 3, 6, or 12 mo postoperatively）,IOP ≥21 mm Hg or ≤5 mm Hg on two consecutive visits, or additional glaucoma surgery performed within12 mo after PCE/ECP.·RESULTS： Overall, mean medicated IOP was reduced from 16.65 mm Hg at baseline to 13.38 mm Hg at 12mo（P 0.0001）. Mean number of glaucoma medications was reduced from 1.88 medications at baseline to 1.48 medications at 12mo（P =0.0003）. At 3mo postoperatively,the success rate was 73.6%（95%CI： 63.3, 81.5）, 57.1% at6mo（95% CI： 46.3, 66.6）, and 49.7% at 12mo（95% CI：38.9, 59.6）. Patient demographic characteristics were not associated with treatment success. The only ocular characteristic associated with treatment success was a higher baseline IOP.· CONCLUSION： Combined PCE/ECP surgery is an effective surgical option for the reduction of IOP and medication burden in glaucoma patients. Patients withhigher baseline IOP levels are most likely to benefit from this procedure.

Refractive outcomes among glaucoma patients undergoing phacoemulsification cataract extraction with and without Kahook Dual Blade goniotomy

Background:Glaucoma patients undergoing phacoemulsification alone have a higher rate of refractive surprise compared to patients without glaucoma.This risk is further increased with combined filtering procedures.Indeed,there are few and conflicting reports on the effect of combined phacoemulsification and micro-invasive glaucoma surgery(MIGS).Here,we look at refractive outcomes of glaucoma patients undergoing phacoemulsification with and without Kahook Dual Blade(KDB)goniotomy.Methods:Retrospective chart review of 385 glaucomatous eyes of 281 patients,which underwent either phacoemulsification alone(n=309)or phacoemulsification with KDB goniotomy(n=76,phaco-KDB)at the University of Colorado.The main outcome was refractive surprise defined as the difference in target and postoperative refraction spherical equivalent greater than±0.5 Diopter(D).Results:Refractive surprise greater than±0.5 D occurred in 26.3%of eyes in the phaco-KDB group and 36.2%in the phacoemulsification group(p=0.11).Refractive surprise greater than±1.0 D occurred in 6.6%for the phacoKDB group and 9.7%for the phacoemulsification group(p=0.08).There was no significant difference in risk of refractive surprise when pre-operative IOP,axial length,keratometry or performance of KDB goniotomy were assessed in univariate analyses.Conclusion:There was no difference between refractive outcomes of glaucomatous patients undergoing phacoemulsification with or without KDB goniotomy.