Abstract
Purpose :
Phacoemulsification cataract surgery (PCS) combined with minimally invasive glaucoma surgery (MIGS) has been shown to be efficacious in a number of studies, however, there is a paucity of comparative data in this area. We conducted a retrospective observational clinical study to evaluate the efficacy, safety and complication rates of PCS when combined with either gonioscopy-assisted transluminal trabeculotomy (GATT) or iStent Inject.
Methods :
This retrospective study compared the outcomes of 37 patients who underwent combined GATT and PCS with 30 patients who underwent combined iStent Inject insertion and PCS. Patients with a variety of glaucoma diagnoses were enrolled. Cases undergoing other intraocular procedures in the same session were excluded. The primary outcome measures were intraocular pressure (IOP), number of glaucoma medications (NGM) and the secondary outcome measures were visual acuity (VA) and complications. Success was defined as IOP<21 mmHg and ≥20% reduction in IOP at 1 year regardless of the NGM. All patients had at least 1 year of follow-up. SPSS version 23.0 was used to perform paired t-test, Mann-Whitney U test and Kaplan-Meier analysis.
Results :
The mean age and pre-operative IOP in the phaco-GATT and phaco-iStent groups were 74.1 ± 13 years and 70.5 ± 13.7 years, and 25.7 ± 9.3 and 18.2 ± 5.8 respectively, with only the latter being statistically significant (P<0.05). In both groups, there was a significant increase in VA and reduction in the IOP and NGM observed post-surgery (P<0.05). At one year, the phaco-GATT group achieved a significantly greater mean IOP reduction of 40.2% (11.4 ± 9.1mmHg) compared to 14.9% (3.3 ± 4.5mmHg) in the phaco iStent group (P<0.01) and a greater mean NGM reduction of 2.3 ± 1.3 in the phaco-GATT group compared to 1.1 ± 1.1 in the phaco-iStent group (P<0.01).
Three patients (8.1%) in the phaco-iStent group required further surgery to reduce the IOP compared to none in the phaco-GATT group. One patient (3.3%) in the phaco-GATT group required anterior chamber washout due to fibrinous uveitis.
At 1 year, the success rate was 35.1% in the phaco-iStent group compared to 93.3% in the phaco-GATT group.
Conclusions :
GATT combined with PCS provides a greater reduction in IOP and NGM than combined iStent Inject and PCS. At 1 year, phaco-GATT group was significantly more successful.
This is a 2020 ARVO Annual Meeting abstract.