Abstract
Purpose :
The purpose of this research is to compare three different approaches to glaucoma management during phacoemulsification cataract surgery (PECS) to reduce intraocular pressure (IOP). (1) PECS with Endoscopic Cyclophotocoagulation (ECP) (PECS/ECP group); (2) PECS with Kahook Dual Blade (KDB) goniotomy (PECS/KDB group); (3) PECS with ECP and KDB goniotomy (PECS/KDB/ECP group). Previous research has explored MIGS procedures combined with PECS however, no study directly compared the efficacy of these against one another.
Methods :
This is a multicenter retrospective observational case series of 82 patients who received either PECS/ECP (n=29), or PECS/KDB (n=26), or PECS/KDB/ECP (n=27). The primary outcome of this project was reduction in IOP. Success was defined as an IOP reduction of at least 20%. Secondary outcomes included improvement in vision, changes in IOP, and changes in number of topical IOP lowering medications. The patients were seen 1 day, 1 week, 1 month, and 6 months postoperatively.
Results :
Mean IOP in the PECS/ECP group went from an average of 16.5 mmHg at baseline to 13.5 mmHg at 6 months (18%). Mean number of medications prescribed in this group went from 1.96 at baseline to 1.36 at 6 months (21%). Vision changes in the PECS/ECP group went from an average of 0.593 (logMAR) at baseline to 0.163 at 6 months.
Mean IOP in the PECS/KDB group went from an average of 17.1 mmHg at baseline to 13.3 mmHg at 6 months (21%). Mean number of medications prescribed in this group went from 2.53 at baseline to 2.28 at 6 months (2%). Mean change in vision changed from an average of 0.481 at baseline to 0.133 at 6 months.
Mean IOP in the PECS/KDB/ECP group went from an average of 16.9 mmHg at baseline to 12.8 mmHg at 6 months (24%). Mean number of medications prescribed in this group went from 2.31 at baseline to 1.5 at 6 months (36%). Mean change in vision changed from 0.707 at baseline to 0.326 at 6 months.
Conclusions :
While all three MIGS procedures were safe and effective in lowering IOP, reducing dependence of topical IOP lowering therapy, and improving vision, there was little statistically significant difference between these procedures when comparing them against one another. Vision was not significantly improved with PECS/KDB (p=0.053) as compared to the combined procedure. Medication burden was significantly reduced in the PECS/KDB/ECP group (p = 0.00128) relative to the PECS/KDB group and PECS/ECP group.
This is a 2020 ARVO Annual Meeting abstract.