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Chang-Sik Kim, Woo-Jin Kim, Woo-Hyuk Lee, Kyung-Nam Kim; Effect of combined phacoemulsification and goniotomy on intraocular pressure in open-angle glaucoma. Invest. Ophthalmol. Vis. Sci. 2018;59(9):457.
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Although goniotomy is a successful and effective surgical technique for the treatment of congenital glaucoma, its effect in adult remains unclear. The purpose of this study is to evaluate the effect of goniotomy on intraocular pressure (IOP) when performed simultaneously with cataract surgery, and to compare it to simple phacoemulsification (PE) and intraocular lens insertion in adult patients with open-angle glaucoma and cataract.
The medical records of 40 eyes who underwent PE alone and 21 eyes who underwent combined PE-goniotomy in patients with primary open angle glaucoma or normal tension glaucoma and cataract were reviewed retrospectively. Success in IOP control was defined as an IOP < 21mmHg without anti-glaucoma medication or with fewer medications than before surgery, and no need for additional glaucoma surgery. The IOP, number of anti-glaucoma medications, success rate of IOP control, and complications for 6 months after surgery were compared.
There were no difference in IOP and number of medications before surgery between 2 groups. The IOP before surgery were 17.3±2.5 mmHg in PE group and 17.8±2.4 mmHg in PE-goniotomy group, and it was decreased to 15.9±3.0 mmHg and 14.5±2.0 mmHg at 6 months after surgery respectively (p=0.008 and <0.001). Also, the number of medications were decreased from 2.0±1.2 and 2.2±1.3 to 1.6±1.3 and 0.9±1.2 in PE group and PE-goniotomy group respectively (p=0.025 and <0.001). The significant lower IOP and fewer medications after surgery were maintained during 6 months in both groups. Although there was no significant difference in IOP at 6 months after surgery between 2 groups (p=0.063), the number of medications were lower in PE-goniotomy group (p=0.044). The cumulative success rate of IOP control during 6 months was greater in PE-goniotomy group than PE group (p=0.017); it was 85.7% and 55.0% respectively at 6 months after surgery. Except for the microhyphema found in 7 eyes (33.3%) on next day after surgery in PE-goniotomy group, there was no clinically significant complication after surgery.
Both PE and PE-goniotomy decreased IOP significantly for 6 months after surgery, and the amount of decrease was greater when goniotomy was added to the simple cataract surgery. The combined PE-goniotomy may be used as a safe and effective procedure in lowering IOP in patients with primary open angle glaucoma and cataract.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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