Combined Phacoemulsification and 360-Degree Endocyclophotocoagulation with and without a Kahook Dual Blade in Patients with Primary Open-Angle Glaucoma

Izquierdo, Juan Carlos; Agudelo, Natalia; Rubio, Bárbara; Camargo, Jorge; Ruiz-Montenegro, Katia; Gajardo, Consuelo; Rincon, Mirel

doi:10.2147/opth.s282440

Cited by 9 publications

(20 citation statements)

References 23 publications

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“…Further, we demonstrate that patients who underwent PEcK, Phaco/ECP, or Phaco/KDB experienced significant reductions in both IOP and medication burden for more than 36 months, which is the first time that PEcK outcomes have been reported for more than 12 months postoperatively. 1 , 2 , 17 …”

Section: Discussionmentioning

confidence: 99%

“…Despite being rarely reported, PEcK was associated in our study with a 12-month reduction in mean IOP of 3.8 mmHg on 1.1 fewer medications, which showed similar efficacy to that reported by Izquierdo et al and Klug et al The latter study suggested potentially greater efficacy of PEcK compared to ICE which had an associated 12-month reduction in mean IOP of 1.4 mmHg on 0.8 fewer medications. 2 , 17 …”

Section: Discussionmentioning

confidence: 99%

“…At 12 months postoperatively, mean IOP was reduced by 5.52 mmHg in the PEcK group, resulting in a 32.5% reduction compared to 20.3% after Phaco/ECP (p = 0.031). 17 Our group has also reported on PEcK (n = 53) in a retrospective study of predominantly mild or moderate glaucoma compared to another cMIGS procedure combining iStent insertion, Cataract extraction, and ECP (ICE). The study found a 12-month mean IOP reduction of 5.1 ± 4.4 mmHg on 1.6 ± 1.5 fewer medications, reporting a signal of potentially greater mean IOP reduction following PEcK compared to ICE (p = 0.08).…”

Section: Introductionmentioning

confidence: 96%

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Combined MIGS: Comparing Additive Effects of Phacoemulsification, Endocyclophotocoagulation, and Kahook Dual Blade

Oberfeld,

Golsoorat Pahlaviani,

Hall

et al. 2023

OPTH

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Purpose Combining two or more MIGS (cMIGS) promises to be more efficacious than single MIGS (sMIGS). This study compared the efficacy of PEcK, which combines Phacoemulsification (Phaco), Endocyclophotocoagulation (ECP), and Kahook dual blade (KDB), relative to both of its constituent sMIGS, Phaco/ECP (Endo Optiks, NJ) and Phaco/KDB (New World Medical, CA) for the first time. Patients and methods Data was collected retrospectively from 1833 visits of 271 patients who underwent PEcK, Phaco/ECP, or Phaco/KDB from 2016–2021 at Massachusetts Eye and Ear. Primary outcomes included Generalized Estimating Equations (GEE) of intraocular pressure (IOP) and medication burden, as well as survival models. Results Mean preoperative IOP was 17.6 ± 5.0 (SD) mmHg on 3.0 ± 1.4 medications in the PEcK group (n = 128), 17.9 ± 5.1 mmHg on 2.2 ± 1.5 medications in the Phaco/ECP group (n = 78), and 16.1 ± 4.3 mmHg on 0.4 ± 1.0 medications in the Phaco/KDB group (n = 65). For more than 36 months, all procedures resulted in significant patterns of IOP and medication reduction (all p < 0.001), before and after statistical adjustment. The reduction pattern in IOP was significantly different when comparing all groups over time and favored PEcK (p = 0.04), but the reduction pattern in medications was not significantly different (p = 0.11). Procedures did not differ in procedural time (p = 0.18) or in survival to maintain ≥20% IOP reduction (p = 0.43) without additional medication or procedure. There was a trend toward significant difference in maintaining IOP ≤ goal IOP that favored PEcK over Phaco/ECP after adjustment (p = 0.09). Conclusion PEcK may confer greater IOP reduction without added procedural time compared to Phaco/ECP and Phaco/KDB in predominantly mild or moderate glaucoma. Further research on cMIGS may benefit from adopting this comparative analysis to constituent MIGS.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

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Combined MIGS: Comparing Additive Effects of Phacoemulsification, Endocyclophotocoagulation, and Kahook Dual Blade

Oberfeld,

Golsoorat Pahlaviani,

Hall

et al. 2023

OPTH

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“…However, the study had similar problems as the study by Ferguson and colleagues; the patients had significantly higher baseline IOP and a more negative mean deviation value than the Phaco/iStent group. Izquierdo et al 174 performed a randomized, prospective study that compared the outcome of uncontrolled OAG patients who underwent combined phacoemulsification, ECP, and KDB (PEcK group) versus phacoemulsification with ECP (Phaco/ECP group). Of the ECP, 360 degrees were performed for both groups, with an additional 120 degrees of pigmented TM removed for the PEcK group.…”

Section: Combined Proceduresmentioning

confidence: 99%

“…Izquierdo et al 174 performed a randomized, prospective study that compared the outcome of uncontrolled OAG patients who underwent combined phacoemulsification, ECP, and KDB (PEcK group) versus phacoemulsification with ECP (Phaco/ECP group). Of the ECP, 360 degrees were performed for both groups, with an additional 120 degrees of pigmented TM removed for the PEcK group.…”

Section: Combined Proceduresmentioning

confidence: 99%

Minimally Invasive Glaucoma Surgery: Latest Developments and Future Challenges

Chan,

Larson,

Dickerson

et al. 2023

Asia-Pacific Journal of Ophthalmology

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The development of minimally invasive glaucoma surgeries (MIGSs) was intended to provide safe and modestly efficacious modalities for early intervention of mild-to-moderate glaucoma, with minimal trauma and rapid recovery. They were mainly ab interno procedures that reduce intraocular pressure by facilitating the aqueous outflow by bypassing the trabecular meshwork resistance, reinforcing the uveoscleral flow via the supraciliary space, and reducing aqueous production by the ciliary body. While the cumulating evidence helps shape the role of the available MIGS, the exponential new development and advancement in this field has expanded the territory of MIGS. Apart from developing subconjunctival MIGS filtration devices (Xen gel stent and PRESERFLO MicroShunt), there is a tendency to revisit the “traditional” MIGS for alternative use and to modify the procedures with consideration of the fundamental aqueous outflow physiology. Combined MIGS has also been suggested, based on the theory that their different mechanisms may provide additive or synergistic effects. The advancement of laser procedures is also promising and could supplement unmet needs along the glaucoma treatment algorithm. This review examines the broad array of MIGS, updates the recent findings, discusses their potential alternative applications, and explores future challenges.

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