Abstract
We compared surgical outcomes in patients with either primary open-angle glaucoma or exfoliation glaucoma after undergoing combined phacoemulsification with either a 120° or 180° incision during a Schlemm’s canal microhook ab interno trabeculotomy (μLOT-Phaco). This retrospective comparative case series examined 52 μLOT-Phaco eyes that underwent surgery between September 2017 and December 2020. Surgical qualified success was defined as an intraocular pressure (IOP) of ≤20 mmHg, ≥20% IOP reduction with IOP-lowering medications, and no additional glaucoma surgery. Success rates were evaluated by Kaplan-Meier survival analysis. The number of postoperative IOP-lowering medications and occurrence of complications were also assessed. Mean preoperative IOP in the 120° group was 16.9 ± 7.6 mmHg, which significantly decreased to 10.9 ± 2.7 mmHg (p < 0.01) and 11.1 ± 3.1 mmHg (p = 0.01) at 12 and 24 months, respectively. The mean number of preoperative IOP-lowering medications significantly decreased from 2.8 ± 1.4 to 1.4 ± 1.4 (p < 0.01) at 24 months. Mean preoperative IOP in the 180° group was 17.1 ± 7.0 mmHg, which significantly decreased to 12.1 ± 3.2 mmHg (p = 0.02) and 12.9 ± 1.4 mmHg (p = 0.01) at 12 and 24 months, respectively. The mean number of preoperative IOP-lowering medications significantly decreased from 2.9 ± 1.2 to 1.4 ± 1.5 (p < 0.01) at 24 months. The probability of qualified success at 24 months in the 120° and 180° groups was 50.4% and 54.6%, respectively (p = 0.58). There was no difference observed for hyphema formation or IOP spikes. Surgical outcomes were not significantly different between the 120° and 180° incisions in Schlemm’s canal.
Highlights
Worldwide, glaucoma is the second most common cause of blindness [1]
In our own recent study, we found that after combined phacoemulsification with either a microhook or a Kahook Dual Blade ab interno trabeculotomy, there was a significant increase in the corneal higher-order aberrations (HOAs) [7]
There were no significant differences observed between the 120◦ and 180◦ incision groups in terms of age, gender, glaucoma type, preoperative intraocular pressure (IOP), and the number of glaucoma eye drops
Summary
Glaucoma is the second most common cause of blindness [1]. Elevated intraocular pressure (IOP) has been reported by several studies to be an important risk factor for glaucoma and disease progression [2,3]. First-line therapy involves topical medications, which have a demonstrated and proven record of efficacy in all adult glaucoma stages. Incisional surgery is often considered when topical medications are not able to adequately reduce the IOP. The greatest resistance for the aqueous humor outflow has been shown to be within the trabecular meshwork, with glaucomatous eyes exhibiting an even greater resistance in this region [4]. Devices and techniques, such as the trabectome, microhook, and Kahook Dual Blade, have been employed as ways for reducing the resistance of the trabecular meshwork
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