Cataract Surgery combined with excimer laser trabeculotomy to lower intraocular pressure: effectiveness dependent on preoperative IOP

Abstract

BackgroundCataract surgery combined with excimer laser trabeculotomy (phaco-ELT) can reduce intraocular pressure (IOP). The aim of this study was to evaluate the effect of phaco-ELT on IOP in patients as a function of preoperative IOP.MethodsPatients with open-angle glacuoma or ocular hypertension who received phaco-ELT between 01/2008 and 10/2009 were included. Patients were assigned based on preoperative IOP either to the study group (≤21 mmHg) or control group (>21 mmHg) in this IRB-approved, prospective, consecutive case series. Visual Acuity, IOP, and number of anti-glaucoma drugs (AGD) were recorded at baseline and 12 months after phaco-ELT. Any postoperative complications were also recorded.Results64 eyes of 64 patients (76.5 ± 9.4 years) were included. Baseline IOP was 19.8 ± 5.3 mmHg (AGD 2.4 ± 1.1) for all eyes, 16.5 ± 2.9 mmHg (AGD 2.5 ± 1.0) for the study group, and 25.8 ± 2.9 mmHg (AGD 2.2 ± 1.4) for the control group. Across the two groups, IOP was reduced by 4.5 ± 5.9 mmHg (-23.0%, p < 0.001) and AGD by 0.9 ± 1.5 (-38.9%, p < 0.001). For the study group IOP was reduced by 1.9 ± 4.4 mmHg (-11. 5 %, p = 0.012) and AGD by 1.1 ± 1.4 (-42.9%, p < 0.001), and for the control group by 9.5 ± 5.4 mmHg (-36.6%, p < 0.001) and AGD by 0.7 ± 1.6 (-29.5%, p = 0.085). There were no serious postoperative complications such as endophthalmitis, significant hyphema, or a severe fibrinous reaction of the anterior chamber.ConclusionsIOP remained significantly reduced from baseline 12 months after phaco-ELT regardless of preoperative IOP levels, with no major complications. The IOP reduction remained constant over the entire follow-up. Hence, phaco-ELT can be considered in glaucoma and ocular hypertensive patients whenever cataract surgery is performed, in order to further reduce IOP or to reduce the requirement for IOP-reducing medications.

Excimer Laser Trabeculostomy (ELT): An Effective MIGS Procedure for Open-Angle Glaucoma

“…Hence, IOP reduction by ELT appears to be effective in both groups, but much more effective in eyes with higher baselirre IOP. This finding has beerr confirmed by a later study [31].…”

Long-term efficacy of combined phacoemulsification plus trabeculectomy versus phacoemulsification plus excimer laser trabeculotomy

“…Excimer laser trabeculotomy (or excimer laser trabeculostomy, ELT) ab interno is one of many MIGS techniques [16]. ELT reduces IOP in patients with glaucoma or ocular hypertension [17,18]. Ten laser channels enhance outflow facility through the juxtacanalicular trabecular meshwork (TM) and inner wall of Schlemmʼs canal [17][18][19][20][21].…”

“…ELT reduces IOP in patients with glaucoma or ocular hypertension [17,18]. Ten laser channels enhance outflow facility through the juxtacanalicular trabecular meshwork (TM) and inner wall of Schlemmʼs canal [17][18][19][20][21]. ELT is performed with either an endoscopic optics or with a gonio lens, and does not interfere with fistulating surgery should it be necessary at a later time.…”

Techniques and outcomes of minimally invasive trabecular ablation and bypass surgery

“…No vision-threatening complications were reported. A recent 1-year-study found that patients with a baseline IOP≤21 (mean 16.5 mm Hg) showed a mean IOP decrease of 12% with 1.1 less medications compared to a decrease of 37% on 0.6 less medications in patients with a baseline IOP above 21 (mean 25.8 mm Hg) 46. Long-term failure is typically caused by migration of immediately adjacent47 or remote cell types 48.…”