Abstract
Purpose :
A variety of literature exists assessing the efficacy and safety of minimally invasive glaucoma surgery (MIGS) techniques in mild-to-moderate disease. However, data on MIGS procedures for treating severe stage primary open-angle glaucoma (POAG) are scarce. The purpose of this study was to evaluate the outcomes of combined goniotomy and phacoemulsification (phaco) among patients with severe stage POAG stratified by their preoperative goal.
Methods :
A retrospective chart review was performed for patients with severe POAG undergoing goniotomy at the time of phaco from 10/23/2019 to 11/10/2022. Goniotomy was performed before phaco, and all surgeries were performed directly by or under the supervision of a single surgeon. Eyes with previous traditional glaucoma surgery were excluded. Surgical success was evaluated based on the patient’s preoperative goal of either lowering IOP or reducing the number of glaucoma medications. All statistical tests were two-tailed, and p<0.05 was considered significant.
Results :
A total of 25 eyes from 21 patients with severe POAG were included. Twelve eyes underwent goniotomy for IOP lowering, and 83% were successful. Mean IOP decreased from 15.4 ± 4.1 mmHg at baseline to 10.6 ± 2.9 mmHg at six months follow-up (p=0.014). Thirteen eyes had acceptable IOP values preoperatively but were scheduled for surgery to address visually significant cataract. For these patients, goniotomy was added to the phaco to reduce medication burden; 77% were successful, and the mean number of glaucoma medications decreased from 3.5 ± 1.1 at baseline to 2.7 ± 1.0 medications at 6 months (p<0.001). The hyphema rate was 12% at POD1, 4% at POW1, and 0% at POM1. Only one eye had an IOP spike (> 30mmHg) and required subsequent IOP-lowering surgery. No other severe complications were reported.
Conclusions :
For patients with severe POAG and visually significant cataract, adding a goniotomy to the phaco may achieve IOP lowering if IOP levels are too high. Alternatively, for patients with IOP levels controlled within their medication regimen, goniotomy may reduce the medication burden while maintaining the same level of IOP control. Incisional glaucoma surgery may still be needed at a future time but starting with goniotomy to enhance physiologic aqueous outflow can be offered to all patients with severe POAG at the time of their phaco.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.