Long-term treatment success and safety of combined phacoemulsification plus excimer laser trabeculostomy: an 8-year follow-up study

Abstract

Purpose Combined phacoemulsification plus excimer laser trabeculostomy (phaco-ELT) is a minimally invasive surgery that effectively reduces intraocular pressure (IOP) in patients with glaucoma and a concomitant diagnosis of cataract. The aim of this study was to evaluate the long-term treatment success as well as safety of phaco-ELT over an 8-year follow-up period. Methods Patients with a diagnosis of primary or secondary glaucoma or ocular hypertension and a visually significant cataract who underwent a combined phaco-ELT between January 1, 2008, and December 31, 2010, were included. Data for IOP, the number of IOP-lowering medications (meds), best-corrected visual acuity, complications, and subsequent surgeries to lower IOP were collected preoperatively (baseline) and intraoperatively as well as at 1 day, 1 week, 1 month, 3 months, 6 months, 9 months, 1 year, and every 6 months thereafter to 8 years postoperatively. Results One hundred sixty-one eyes of 128 patients were included. After 8 years of follow-up, the long-term treatment success rate with IOP ≤ 21 mmHg was 50.2%. No serious intra-or postoperative complications occurred. The mean IOP decreased significantly from 19.3 (±4.8) mmHg at baseline to 15.4 (±3.2, p =0.0040) mmHg at 8 years. Additionally, meds remained below baseline after 8 years of follow-up and were reduced significantly for up to 4 years. Only 25.5% of the eyes required a subsequent surgery to lower IOP during the follow-up period. Conclusion Combined phaco-ELT is a safe procedure without serious intra-or postoperative complications, which has a positive long-term effect regarding IOP and meds. Remarkably, the mean IOP-lowering effect remained stable and was reduced ≥ 20% from baseline after 3 months for the remainder of the follow-up duration, whereas the number of meds was reduced significantly for up to 4 years. Furthermore, only 25.5% of the eyes required a subsequent surgery to control IOP throughout the whole follow-up of 8 years. Key messagesCombined phacoemulsification plus excimer laser trabeculostomy (phaco-ELT) is a minimally invasive glaucoma surgery procedure that effectively reduces intraocular pressure (IOP) in patients with glaucoma and a concomitant diagnosis of cataract.In this study, a sustained and significant IOP reduction over an eight-year follow-up duration was observed, whereas the number of IOP-lowering medications used was reduced significantly for up to four years.Combined phaco-ELT is a safe procedure without serious intra-or postoperative complications. Subsequent glaucoma surgeries were avoided in most patients who underwent phaco-ELT over eight years.The paper referenced as no.

First-in-Human Safety Study of Femtosecond Laser Image-Guided Trabeculotomy for Glaucoma Treatment

“…Given an analogous principle of action between the 2 methods, it is interesting to note the ELT channel patency has been documented to 5 years and IOP reduction has been reported to the 8-year time point. 30 , 31 32 …”