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Stella N. Arthur, Darrell WuDunn, Louis B. Cantor, Guruprasad R. Pattar, Yara Catoira-Boyle, Linda S. Morgan, Joni S. Hoop; Efficacy, Safety, And Survival Rates Of Iop-lowering Effect Of Phacoemulsification Alone Or With Canaloplasty In Glaucoma Patients. Invest. Ophthalmol. Vis. Sci. 2011;52(14):626.
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To evaluate efficacy, safety, and success rates of IOP-lowering effect obtained with phacoemulsification (phaco) alone or with canaloplasty (PCP) in patients with open angle glaucoma (OAG).
Retrospective chart review of consecutive phaco from 4/30/2007 to 4/15/2010 performed by 3 surgeons (DW, LBC, and YBC) and PCP from 5/14/2007 to 7/19/2010 performed by 1 surgeon (LBC) in OAG patients. Visual acuity (VA), intraocular pressure (IOP), number of medications, and complications were analyzed. Failure criteria were: IOP more than 21 mmHg or less than 20% reduction; persistent IOP less than 6 mmHg; and loss of light perception vision.
37 patients (16 African-Americans [AA] and 21 Caucasian [C]) underwent phaco and 32 (1 AA and 31 C) PCP. Follow-up (f/u) was 19.1±8.7 vs. 16.0±10.5 months for phaco and PCP respectively (p=0.18). Age (years) (74.7±9.8 vs. 76.4±8.4, p=0.44), gender (p=0.81), and laser status (p=0.60) were similar between 2 groups.Pre-operatively, mean±SD logMAR VA (0.5±0.7 vs. 0.5±0.5, p=0.85); IOP (16.2±4.6 vs. 18.2±5.1, p=0.10); and number of medications (1.4±1.1 vs. 1.3±0.7, p=0.88) were similar for phaco and PCP respectively.At 3 months, phaco (n=34) and PCP (n=32) mean±SD were: logMAR VA (0.2±0.2 vs. 0.3±0.3, p=0.93); IOP (14.1±3.1 vs. 12.2±3.7, p=0.03); and medications (0.9±1.0 vs. 0.1±0.3, p<0.0001).At 12 months phaco (n=34) and PCP (n=22) mean±SD were: logMAR VA (0.2±0.2 vs. 0.3±0.4, p=0.52); IOP (13.9±3.2 vs. 12.5±3.2, p=0.10); and medications (1.3±1.2 vs. 0.1±0.3, p<0.0001).At 18 months phaco (n=21) and PCP (n=14) mean±SD were: logMAR VA (0.1±0.1 vs. 0.4±0.7, p=0.10); IOP (13.5±3.5 vs. 14.1±3.6, p=0.65); and medications (1.2±1.3 vs. 0.2±0.4, p=0.03).At 24 months phaco (n=17) and PCP (n=11) mean±SD were: logMAR VA (0.2±0.2 vs. 0.5±0.8, p=0.38); IOP (14.1±3.9 vs. 13.2±3.7, p=0.56); and medications (1.6±1.2 vs. 0.3±0.5, p=0.007).Complications for phaco were IOP spikes (n=12) and for PCP were hyphema (n=7), IOP spikes (n=6) and Descement window rupture intraoperatively (n=1).Success rates for phaco vs. PCP at 12 months were 75% vs. 86%, at 18 months 56% vs. 86%, and at 24 months 50% vs. 72%. The differences were statistically significant (p=0.01).
PCP had higher success rate of IOP-lowering effect than phaco alone in patients with open angle glaucoma. The use of glaucoma medications postoperatively was significantly lower with PCP than with phaco.
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