Abstract
Purpose :
Minimally invasive glaucoma surgery (MIGS) has recently emerged as an effective procedure to lower intraocular pressure (IOP) in patients with mild-to-moderate glaucoma. However, differences in surgical outcomes between two trabecular MIGS procedures, OMNI canaloplasty with goniotomy (OMNI) and goniotomy alone, are unclear. This retrospective cohort study compares the safety and efficacy of these procedures at 1 year post operation.
Methods :
A retrospective analysis was performed on mild-to-moderate glaucoma patients who underwent phacoemulsification with OMNI or with goniotomy alone. The mean number of ocular hypotensive medications and IOP were assessed preoperatively and postoperatively at 1 year. The primary outcome was surgical success, defined as attaining the target IOP at 1 year without additional medications or glaucoma procedures. Eyes were matched (1:1) based on age, race, sex, glaucoma type and severity, baseline and target IOP, baseline number of medications, and if target pressure was met at baseline. Statistical analysis included paired t-tests and chi-squared tests.
Results :
Our 68-eye cohort (34 OMNI, 34 goniotomy) had a mean baseline IOP of 17.7±5.8 mmHg and 19.8±6.8 mmHg and mean baseline number of medications of 1.50±1.50 and 1.59±1.31 for the OMNI and goniotomy groups, respectively. Mean IOP at 1 year was 14.5±4.0 mmHg (18.1% reduction; p<0.05) and 16.0±5.7 mmHg (19.1% reduction; p<0.05) for OMNI and goniotomy, respectively. Mean number of medications at 1 year were 0.76±1.27 (49.0% reduction; p<0.05) for OMNI and 0.68±1.27 (57.4% reduction; p<0.05) for goniotomy. Surgical success at 1 year was 79.4% for OMNI and 73.5% for goniotomy (p>0.05 between groups). At one year, 61.8% of OMNI and 70.6% of goniotomy patients were medication-free (p>0.05). Adverse events occurred in both groups, including corneal edema, steroid response, and hyphema.
Conclusions :
OMNI and standalone goniotomy effectively reduce IOP and medication dependency at 1 year, showing similar surgical success rates. While they show similar IOP reduction, goniotomy resulted in a greater decrease in medication use. Adverse events occuring in both procedures highlights the need for careful patient selection and post-op care. These findings underscore the efficacy of both OMNI and goniotomy in the management of glaucoma during cataract surgery.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.