Outcomes of Phaco-viscocanalostomy in Primary Open Angle Glaucoma versus Pseudoexfoliation Glaucoma.

Ebrahim Azaripour,Soheil Soltanipour,Shila Kianmehr,Abdolreza Medghalchi,Reza Soltani-Moghadam,Hassan Behboudi,Yousef Alizadeh,Zahra Moravvej,Yaser Khakpour

doi:10.18502/jovr.v16i4.9746

Abstract

PurposeViscocanalostomy represents an alternative to standard penetrating glaucoma surgery. The aim of this study is to compare the outcomes of combined phacoemulsification and viscocanalostomy in eyes with primary open-angle glaucoma (POAG) versus eyes with pseudoexfoliation glaucoma (PEXG).Methods In this prospective non-randomized comparative study, eyes with cataract and POAG or PEXG were enrolled. Pre- and postoperative data including best corrected visual acuity (BCVA), intraocular pressure (IOP), and the number of antiglaucoma medications administered were recorded at each visit. All patients underwent phacoviscocanalostomy. Complete success was defined as the IOP of 21 mmHg or less without the administration of medication while a qualified success reported the same IOP parameters either with or without the administration of medication.ResultsFifty-four eyes with POAG and fifty-four with PEXG underwent phacoviscocanalostomy. The mean follow-up time was 23.36 8.8 months (range, 6–40 months). The mean postoperative IOP reduced significantly in both groups, although the mean IOP reduction was significantly greater in PEXG eyes (14.7 8.9 vs 10.1 7.7 mmHg) (P = 0.05). At the final follow-up visit, the mean postoperative IOP was 14.1 2.1 and 16.6 3.5 mmHg in the PEXG and POAG eyes, respectively (P = 0.001). A complete success rate of 88.9% and 75.9% was achieved in PEXG and POAG eyes, respectively (P = 0.07). The qualified success rate was 100% in the PEXG and 85.2% in POAG groups (P = 0.03).ConclusionPhacoviscocanalostomy achieved significant IOP reduction and visual improvement in both POAG and PEXG patients. Our results indicated that in terms of IOP reduction, this procedure was more effective in treating PEXG.

Highlights

METHODSPrimary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PEXG) are chronic and progressive processes causing optic neuropathy
There was no significant difference between the PEXG and the primary open-angle glaucoma (POAG) groups in terms of glaucoma severity (P = 0.585)
The gonioscopy results revealed slightly narrower angles in the PEXG group as compared to the POAG group, this difference was not statistically significant (79.6% in PEXG vs 100% in POAG were classified as open-angle, P = 0.057)

Summary

Introduction

Primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PEXG) are chronic and progressive processes causing optic neuropathy. Pseudoexfoliation syndrome is featured by the deposition of specific fibrillar material in the anterior segment of the eye.[1, 2] This sedimentation of material on the trabecular meshwork (TM) may cause glaucoma and subsequent optic neuropathy.[3]. Various surgical procedures exist for managing glaucoma; these include penetrating and nonpenetrating filtering procedures and tube shunt surgery.[4, 5] Nonpenetrating procedures, such as deep sclerectomy and viscocanalostomy (VCS) have been designed to alleviate the complications of penetrating surgery[6]. VCS, as defined by Stegmann et al, involves the injection of high-viscosity sodium hyaluronate into the Schlemm’s canal until aqueous outflow drainage is improved.[7] It has been suggested that physiologic aqueous humor drainage may be attained without bleb formation

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