Abstract
Purpose :
This retrospective study aims to evaluate the effects of combined goniotomy and phacoemulsification in patients with primary angle closure glaucoma (PACG). The measured outcomes are IOP reduction and the glaucoma medication usage.
Methods :
This is an IRB-approved retrospective chart review for a multi-surgeon, large academic center using the CPT code 65820 for goniotomy from January 2012 to May 2022. Charts were individually reviewed and only Kahook Dual Blade and TrabEx surgeries for diagnosis codes of primary angle closure glaucoma and chronic angle closure glaucoma patients were included in the analysis. Intraocular pressure (IOP) measurements and medication burden were recorded up to latest time point after surgery. Patients with inadequate follow up were excluded. Data points were collected up until a subsequent glaucoma surgery, if applicable. No patients in this study received oral glaucoma medications. Primary clinical outcomes characterized were the mean IOP and number of current IOP-reducing medications being used at baseline, 1 month, 3 months, 6 months, 1 year, and 2 years.
Results :
Among the 42 eyes that underwent surgery, IOP at baseline, 1 month, 3 months, 6 months, 1 year, and 2 years were 20.3 ± 6.2 mmHg (n=42), 15.3 ± 4.7 mmHg (n=42, p< 0.001), 15.1 ± 3.1 mmHg (n=30, p<0.001), 14.6 ± 4.1 mmHg (n=25, p< 0.001), 16.9 ± 3.2 mmHg (n=16, p< 0.005), and 15.4 ± 3.3 mmHg (n=9, p< 0.05) respectively. Number of topical glaucoma medications at baseline, 1 month, 3 months, 6 months, 1 year, and 2 years were 1.8 ± 1.5 (n=42), 1.7 ± 1.1 (n=42, p=0.74), 1.7 ± 1.4 (n=30, p=0.40), 1.2 ± 1.4 (n=25, p=0.28), and 2.1 ± 1.7 (n=9, p=0.30) respectively.
Conclusions :
This study suggests that combined phacoemulsification and goniotomy results in significantly decreased IOP over a 2 year postoperative period while glaucoma medication use remained similar. This IOP reduction appears to be greater than the same time period studied in the EAGLE study after cataract surgery alone. Future studies should be aimed at validating whether the addition of goniotomy to cataract surgery for primary angle closure patients provides further benefits beyond phacoemulsification alone.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.