Abstract
Purpose :
Many studies have shown the efficacy of goniotomy alone or combined with phacoemulsification in reducing post-operative intraocular pressure (IOP) and glaucoma drops. However, few have studied outcomes from both surgeries or had extended follow-up periods. We present a retrospective review of a single institution’s longitudinal outcomes of goniotomy versus goniotomy with phacoemulsification in treatment of primary open-angle glaucoma (POAG).
Methods :
We performed a retrospective chart review of POAG patients undergoing goniotomy between January 2012 and May 2022 at the Cole Eye Institute. Patients who underwent Kahook Dual Blade and TrabEx with and without cataract extraction for the diagnosis of POAG were included. IOP and number of glaucoma drops were recorded at various time points up until last follow-up or until another glaucoma procedure was performed. Wilcoxon rank sum tests were used to determine significance between groups. Surgical success was defined as IOP reduction of at least 20% and/or reduction of at least one glaucoma medication.
Results :
387 eyes were included. 44 eyes underwent goniotomy and 343 underwent combined goniotomy and phacoemulsification. Age, gender, and baseline IOP did not significantly differ between groups. At one year, the goniotomy group (n=27) had more IOP reduction compared to the combined group (n=224) with a decrease of 3.83 ± 3.91 versus 1.48 ± 5.21(p=0.007). There was no difference in medication reduction at one year. No differences were found in goniotomy versus combined groups at 2 years (0.78 ± 4.41 vs. 1.44 ± 3.68 mmHg, p=0.42; 0.50 ± 1.30 vs. 0.42 ± 1.23 drops, p=0.89) or at 3 years (2.82 ± 4.38 vs. 1.38 ± 4.61 mmHg, p=0.49; 0.73 ± 1.49 vs. 0.20 ± 1.08 drops, p=0.38). 66.7% of goniotomy eyes and 50.5% of combined surgery eyes achieved surgical success at one year. At two and three years, these percentages decreased to 44.4% and 45% in goniotomy-treated eyes but stayed at 50.0% and 55% in combined surgery-treated eyes.
Conclusions :
In our preliminary analysis, goniotomy-treated eyes had greater IOP reduction and surgical success compared to eyes treated with combined goniotomy and cataract extraction at one year. However, at year two and three, there was comparable IOP reduction, medication reduction, and surgical success. Our results are limited by selection bias and significant uneven cohort sizes between groups.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.