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M. R. Malen, L. B. Cantor, D. WuDunn, L. Morgan, J. S. Hoop; Early Outcomes Comparing Combined Phacoemulsification/Canaloplasty to Phacoemulsification Alone. Invest. Ophthalmol. Vis. Sci. 2010;51(13):609.
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To assess the efficacy and complications of P/C compared to P alone in glaucoma patients with up to 2 years of follow-up.
Retrospective analysis of 53 eyes (40 patients) undergoing P/C and P at the Indiana University School of Medicine. Twenty-one eyes underwent canaloplasty combined with cataract surgery (P/C), while 32 eyes underwent cataract extraction alone (P). Main outcome measures included intraocular pressure (IOP), number of glaucoma medications, and visual acuity (by logMAR).
Mean age was 76.5 +/- 10.3 years; 17 men, 23 women; 30 Caucasians, 10 African-Americans. There were no significant baseline differences in IOP or in the number of medications (p=0.53) for any post-op time point between the two groups. The difference in pre-op IOP was statistically different between the two groups (P/C vs. P only: 19.3 +/- 7.7 vs. 15.5 +/- 4.9 mmHg, p=0.03, t test). At one year (12-18 months), IOPs were similar (12.9 +/- 4.3 vs. 12.4 +/- 3.0, p=0.65, t test) but the drop in IOP at 12-18 months was greater in the P/C group (7.7 +/- 6.4 vs. 2.4 +/- 5.7 mmHg, p=0.01). The drop in number of medications from pre-op to last visit was statistically significant for both groups (p=0.0017 for P/C group; p=0.005 for P only group, Wilcoxen signed ranks matched pairs test). Post-op complications for P/C phacoemulsification included iritis (1 eyes, 5%), hyphema (7 eyes, > 33%), retained viscoelastic (2 eyes, 10%) and macular edema (1 eye, > 5%). Post-op complications for phacoemulsification included iritis (2 eyes, 6%) and macular edema 1 eye, 3%). Overall the improvement in vision (pre-op vs. post-op) was statistically significant (p<0.0001,Wilcoxen matched pairs signed ranks test), for P/C (p=0.034, Wilcoxen), and for P only (p<0.0001, Wilcoxen). The improvement in vision in the P only group was significantly better than the improvement in vision in the P/C group (0.035, Mann-Whitney test).
Both P only and P/C are effective in reducing the IOP and number of glaucoma meds following surgery in most patients over the short term. The long-term effectiveness of both procedures is unknown
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