Combined Clear Cornea Phacoemulsification with Ab-interno Trabeculo-canalectomy (AITC): A Pilot Study

Abstract

Abstract: : Purpose: To evaluate the efficacy and safety of a novel surgical approch -Ab-interno trabeculo-canalectomy (AITC)- in combined procedure (clear cornea phacoemulsification + AICT) for the management of concurrent cataract and glaucoma at high risk of failure for filtering surgery. Methods: A prospective interventional pilot study was carried out on 11 eyes of 11 consecutive cataract patients with medically uncontrolled primary open angle glaucoma (POAG). All subjects underwent phacoemulsification + intraocular lens implantation + AITC, which consists of a gonioscopically-controlled ab-interno removal of a quadrant (three clock hours) of the trabecular meshwork. Results: Ten patients completed a 1 year of follow-up. One patient underwent further surgery because of poor intraocular pressure (IOP) control; in this case the last valid observation was carried forward for IOP calculation. Mean preoperative IOP and IOPs measured 1, 3, 6 and 12 months after surgery were 25.2, 15.8, 15.4, 15.4 and 15.2 mmHg respectively. Number of medications averaged 2.4 before surgery and dropped to 0.6 at one year follow-up. No severe intraoperative or postoperative complications were observed. Conclusions: The new surgical procedure combining phacoemulsification with AITC can induce a clinically relevant decrease in IOP in eyes with cataract and POAG with poor prognosis for filtering surgery. More extended follow-up, however, and larger series of patients are needed to ascertain the actual effectiveness of this procedure in POAG.

Keywords: clinical (human) or epidemiologic studies: out • trabecular meshwork • outflow: trabecular meshwork