Outcomes of phacoemulsification and endoscopic cyclophotocoagulation performed with dual blade ab interno trabeculectomy or trabecular micro-bypass stent insertion

Abstract

Background/Objective To report the initial outcomes of phacoemulsification, endoscopic cyclophotocoagulation, and dual blade ab interno trabeculectomy (PEcK), and compare them to those of phacoemulsification, endoscopic cyclophotocoagulation, and trabecular micro-bypass stent insertion (ICE-1). Subjects/Methods Patients from January 2018 to December 2019 that underwent PEcK or ICE-1 at a tertiary referral centre were included in this retrospective comparative case series. Patients were excluded if they had additional concomitant procedures, less than 6 weeks (42 days) of follow-up or were not at least 18 years old. Intraocular pressure (IOP), number of glaucoma medications, and best-corrected visual acuity were collected preoperatively and postoperatively at 6 weeks, 3, 6, and 12 months. Kaplan–Meier survival analysis and Cox proportional-hazards regression were conducted to elucidate any factors associated with survival time. Results The mean preoperative IOP was 18.3 ± 5.9 mmHg in the PEcK group (53 eyes) and 14.7 ± 4.3 mmHg in the ICE-1 group (23 eyes) (p = 0.004) on 3.3 ± 1.3 and 1.7 ± 0.93 glaucoma medications (p < 0.001), respectively. Twelve months postoperatively the mean IOP reduction was 5.1 ± 4.4 mmHg and 2.3 ± 4.0 mmHg (p = 0.08), and the mean medication reduction was 1.6 ± 1.5 and 0.97 ± 0.66 (p = 0.10), in the PEcK and ICE-1 groups, respectively. Kaplan–Meier survival analysis did not reveal any differences in treatment survival. Conclusions Both PEcK and ICE-1 provide clinically relevant reductions in IOP and glaucoma medication burden, however the PEcK procedure may confer greater reductions in IOP. The procedures did not differ with regard to Kaplan–Meier survival probability.

Endocyclophotocoagulation combined with phacoemulsification in surgically naive primary open-angle glaucoma: three-year results

“…Notably, phaco-ECP required a lower number of reinterventions (10% vs 14%). Several conjunctival-sparing alternatives to trabeculectomy such as ab interno trabeculectomy [30] and canaloplasty [31] have been developed leading to comparisons [32] and combinations [33,34] with phaco-ECP, with phaco-ECP plus dual blade ab interno trabeculectomy (PEcK) providing an IOP reduction of 5.1 ± 4.4 mmHg at 12 months [34]. However, such Visual field, dB (mean ± SD) MD -13.1 ± 9.4 -11.7 ± 8.4 -13.5 ± 9.5 -13.1 ± 9.7 PSD 6.2 ± 3.3 6.6 ± 3.9 6.5 ± 3.3 6.3 ± 3.5…”

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

“…The goal IOP was a preoperatively designated target that corresponded to a 20% IOP reduction from the level at which glaucoma progression was first documented. 2 …”

“…This study focuses on the hypothesis that PEcK, a specific cMIGS that combines Phacoemulsification (Phaco), Endocyclophotocoagulation (ECP; Endo Optiks, NJ, USA), and Kahook dual blade (KDB; New World Medical, CA, USA), yields greater IOP reduction, medication reduction, and survival than its constituent MIGS, while maintaining procedural time and safety. 2 …”

Minimally Invasive Glaucoma Surgery: Latest Developments and Future Challenges

“…Of note, the study had a small sample size (49 eyes) and only involved patients with uncontrolled OAG. Interestingly, Klug et al 175 retrospectively compared the efficacy of PEcK and ICE for patients with different types of OAG. At baseline, patients in the PEcK group (53 eyes) had higher mean preoperative IOP (18.3 ± 5.9 mm Hg), required more medication (3.3 ± 1.3), and had a larger proportion of moderate-to-serve glaucoma (39.6%) than the ICE group (23 eyes) (14.7 ± 4.3 mm Hg, 1.7 ± 0.93, and 0%, respectively, all P ≤ 0.004).…”