Combined Glaucoma Procedures Effective in Pseudophakic Eyes

Cataract Patients Receive Free Treatment in Bali's Capital
DENPASAR, BALI, INDONESIA – MARCH 01: Doctors perform cataract surgery on the eye of a patient at Udayana Army Hospital on March 1, 2014 in Denpasar, Bali, Indonesia. More than 400 patients received free cataract surgery at Udayana Army Hospital as part of a drive to improve the eye health of members of poorer communities in Indonesia, which has one of the highest rates of blindness in the world and also highest in South East Asia. (Photo by Agung Parameswara/Getty Images)
A MIGS procedure is efficacious in patients with glaucoma in eyes that have already undergone cataract surgery.

Combined ab interno canaloplasty and trabeculotomy as a standalone procedure appears to be efficacious in reducing intraocular pressure (IOP) and the medication burden in patients with pseudophakic eyes and open-angle glaucoma, according to research published in Clinical Ophthalmology

Investigators conducted a retrospective, consecutive case series of 67 pseudophakic eyes of 52 patients (mean age, 76.5±8.9 years; 67.7% women and 33.3% men). with open-angle glaucoma who underwent a combined procedure using a minimally invasive glaucoma surgery (MIGS) device that delivers up  to 360° ab interno canaloplasty and up to 360° trabeculotomy without accompanying cataract surgery. They evaluated short-term outcomes, including mean IOP and number of glaucoma medications, and data collected prior to surgery and 6-month after. 

The study shows that the pressure-lowering effects of the combined ab interno canaloplasty and trabeculotomy procedure were sustained at 6 months. Patients had a preoperative mean IOP of 22.1±8.0 mm Hg and took on average 2.3±1.4 glaucoma medications. Both those numbers dropped postoperatively to a mean 15.2±4.9 mm Hg (P <.001) and 0.7±1.4 medications (P <.001). The team also observed a surgical success rate (defined as a 20% reduction in IOP with no increase in glaucoma medication, or discontinuation of ≥1 glaucoma medication with no increase in IOP) of 69.8%.

The most common adverse event observed was hyphema (40%) during the immediate postoperative period.

“As evidence supporting the safety and efficacy of MIGS + cataract surgery continues to emerge, there is increased interest in the use of MIGS as a standalone option for pseudophakic eyes with poorly controlled primary open-angle glaucoma,” according to the study authors. This surgical system provides the “potential for additional IOP and medication reduction, especially in eyes that have already experienced the pressure-lowering effects of cataract surgery.”

Disclosure: This research was supported by Sight Sciences, Inc. Multiple study authors declared affiliations with the biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Bleeker AR, Litchfield WR, Ibach MJ, et al. Short-term efficacy of combined ab interno canaloplasty and trabeculotomy in pseudophakic eyes with open-angle glaucoma. Clin Ophthalmol. 2022;16:2295-2303. Published 2022 Jul 21. doi:10.2147/OPTH.S367896