Effect of combined goniotomy and phacoemulsification on intraocular pressure in open‐angle glaucoma patients

Kim, Woo Jin; Kim, Ju‐Mi; Lee, Woo‐Hyuk; Kim, Kyoung Nam; Kim, Chang Sik

doi:10.1111/ceo.13506

Cited by 8 publications

(10 citation statements)

References 47 publications

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“…The presence of posterior capsular opacification in some eyes is the reason for the measured CDVA at six months. A fundamental difference between our study and previous studies[ 20 22 24 ] was that we did phacoemulsification before goniotomy. Experimentally, we did direct gonioscopy before and after phaco alone surgery and recognized the angle is wider and more suitable for goniotomy after phacoemulsification and posterior chamber IOL implantation.…”

Section: Discussionmentioning

confidence: 77%

“…Kim et al . [ 24 ] in a study compared combined phaco and conventional needle goniotomy with phaco alone in OAG patients. Mean IOP and number of medications at 3, 6, and 12 months after the procedure was not different between groups while the drop of IOP was significantly higher in the combined surgery group at 3 (13.7% versus 6.3%), 6 (17.5% versus 8.6%), and 12 (17.0% versus 8.0%) months.…”

Section: Discussionmentioning

confidence: 99%

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Six-month outcomes of combined conventional needle goniotomy and phacoemulsification in eyes with early to moderate primary open-angle and pseudoexfoliation glaucoma and ocular hypertension

Tabatabaei

Eslami

Mohammadi

et al. 2022

Indian Journal of Ophthalmology

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Purpose: Angle-based surgeries for the treatment of open-angle glaucoma have gained popularity in recent years. This study aimed to evaluate the efficacy of combined phacoemulsification and goniotomy in primary open-angle and pseudoexfoliation glaucoma (POAG and PXG) and ocular hypertension (OHTN). Methods: In this interventional case series in the setting of the Glaucoma Service at the Farabi Eye Hospital, 32 eyes of 30 patients with early-to-moderate POAG and PXG and OHTN were enrolled. All eyes underwent combined phacoemulsification and needle goniotomy. Intraocular pressure (IOP) and the number of antiglaucoma medications as well as demographic data were recorded at baseline and one day, one week, one month, three months, and six months after the surgery. Generalized Estimating Equation (GEE) was used to compare the values of IOP and the number of medications at different time points. Kaplan–Meier graph was used to demonstrate the survival status of the eyes. Results: Mean IOP at baseline was 21.8 ± 4.6 mmHg on mean 1.2 ± 1.5 topical medications. There was a 25.2% (16.3 ± 4.5 mmHg) and 32.1% (14.8 ± 3.9 mmHg) reduction in IOP at three and six months after procedure, respectively ( P < 0.001). Meanwhile, the decline in medications was 66.7% (0.4 ± 0.9) and 50.0% (0.6 ± 1.1) at the same time points ( P = 0.002 and P = 0.048, respectively). Post-operative complications were clot hyphema ( n = 1, 3.1%), fibrinous inflammation ( n = 1, 3.1%) and distorted pupil ( n = 2, 6.3%). Conclusion: Combined phacoemulsification and needle goniotomy as a procedure for mild and moderate POAG and PXG and OHTN is as effective as other modified goniotomies in the setting of minimally invasive glaucoma surgeries (MIGS).

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Six-month outcomes of combined conventional needle goniotomy and phacoemulsification in eyes with early to moderate primary open-angle and pseudoexfoliation glaucoma and ocular hypertension

Tabatabaei

Eslami

Mohammadi

et al. 2022

Indian Journal of Ophthalmology

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“…It could be done as a standalone surgery or combined with cataract surgery. 17 In this study, we compared phacoemulsi cation alone versus combined phaco-goniotomy in patients with cataract and POAG in terms of IOP control, the number of antiglaucoma medications, and safety pro le. We found a signi cant reduction of IOP in patients with moderate glaucoma who had combined phacogoniotomy.…”

Section: Discussionmentioning

confidence: 99%

Impact of Phacoemulsification versus combined Phacoemulsification-goniotomy on intraocular pressure in primary open-angle glaucoma patients

Awwad

Helal

Hamouda

et al. 2022

Preprint

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Purpose:To assess the effect of phacoemulsification and combined phacoemulsification-goniotomy on intraocular pressure (IOP) in patients with primary open-angle glaucoma (POAG). Setting: Benha University HospitalDesign: A retrospective, observational, cohort study Patients and Methods:Sixty patients with cataract and POAG were allocated into two groups; group (P) had phacoemulsification, while group (PG) had combined phacoemulsification-goniotomy. Patients were subdivided into subgroups moderate (Pm and PGm) and severe (Ps and PGs) glaucoma based on the American Glaucoma Society classification of glaucoma severity. All patients had their presenting IOP, medicated IOP, number of IOP lowering medications, and postoperative IOP recorded. Postoperative IOP and IOP lowering drops number were followed up for 24 months after surgery. All intraoperative and postoperative complications were recorded and managed accordingly. Results:Group (P) showed an IOP reduction from 33±1.9 and 35±0.54 to 28±1.2 and 31±0.83 mmHg in subgroups Pm and Ps, respectively on the first postoperative week. All patients in group P needed to reinstate the IOP lowering drops with a non-significant change in the number of IOP reducing drops by the end of the study. In group (PG), a highly significant reduction in postoperative IOP was noted in the first postoperative week from 31±0.9 and 34±0.29 to 14±0.9 and 26±1.2 mmHg in subgroups PGm and PGs respectively P-value <0.0001). Patients with moderate glaucoma had stopped all IOP lowering drops, while those with severe glaucoma needed fewer medications by the end of the study.Conclusion:Combined phacoemulsification-goniotomy is superior to phacoemulsification alone in cases of POAG in terms of IOP control, especially for moderate POAG.

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“…We also found that the 3 surgeries decreased IOP and ocular hypotensive medications when compared with their own baseline, which is similar to other studies comparing IOP decrease and medication reduction. 17,20,21,[39][40][41][42][43] However, while this type of analysis within groups is simple and demonstrates the greatest effect on IOP lowering and medication burden, a comparison between groups is difficult because of preoperative and postoperative differences in IOP and ocular hypotensive medications. When we subdivided the groups based on the number of medications (1, 2, or 3+) the difference between group remained nonsignificant.…”

Section: Discussionmentioning

confidence: 99%

Intraocular Pressure and Medication Burden With Cataract Surgery Alone, or Cataract Surgery Combined With Trabecular Bypass or Goniotomy

McNiel

Sanchez

Rees

et al. 2022

Journal of Glaucoma

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Précis: When compared with cataract surgery in glaucoma patients, trabecular micro-bypass and goniotomy resulted in a large decrease in the incidence of intraocular pressure (IOP) spikes, a modest effect on IOP, and a minimal effect on medication burden. Purpose: To compare changes in IOP and ocular hypotensive medications in 3 surgical cohorts: cataract surgery, cataract surgery with trabecular micro-bypass (cataract/trabecular), and cataract surgery with goniotomy (cataract/goniotomy). Materials and Methods: We included 138 eyes diagnosed with open-angle glaucoma: (1) 84 eyes with cataract surgery alone, (2) 25 eyes with cataract/trabecular surgery, and (3) 29 eyes with cataract/goniotomy surgery. We compared the groups for postoperative IOP and the number of ocular hypotensive medications. We adjusted for preoperative IOP, and preoperative and postoperative number of ocular hypotensive medications. We defined an IOP spike as IOP ≥21 mm Hg and 10 mm Hg higher than preoperative on postoperative day 1. Results: All 3 surgeries showed a decrease in IOP (P≤0.004) and medication burden (P≤0.001) at 3 and 6 months postoperatively when compared with their own preoperative baselines. When compared with cataract surgery alone, cataract/trabecular and cataract/goniotomy had similar IOP lowering at 1 month postoperatively, and variable results at 3 and 6 months. The change in ocular hypotensive medications was not statistically different between the surgical groups at any postoperative visit. Cataract/trabecular and cataract/goniotomy decreased IOP on postoperative day 1, and had relative risk reduction of ~70% for IOP spikes (P≤0.001 for both). Conclusion: Trabecular micro-bypass and goniotomy when added to cataract surgery resulted in a large decrease in IOP spikes, a modest effect on IOP, and a minimal effect on medication burden when compared with cataract surgery alone in glaucoma patients.

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Effect of combined goniotomy and phacoemulsification on intraocular pressure in open‐angle glaucoma patients

Cited by 8 publications

References 47 publications

Six-month outcomes of combined conventional needle goniotomy and phacoemulsification in eyes with early to moderate primary open-angle and pseudoexfoliation glaucoma and ocular hypertension

Six-month outcomes of combined conventional needle goniotomy and phacoemulsification in eyes with early to moderate primary open-angle and pseudoexfoliation glaucoma and ocular hypertension

Impact of Phacoemulsification versus combined Phacoemulsification-goniotomy on intraocular pressure in primary open-angle glaucoma patients

Intraocular Pressure and Medication Burden With Cataract Surgery Alone, or Cataract Surgery Combined With Trabecular Bypass or Goniotomy

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