Combined Phaco, Trabeculectomy, Endoscopic Cyclophotocoagulation Effectively Lowers IOP

Combining phacoemulsification, ab-interno trabeculectomy, and endoscopic cyclophotocoagulation (ECP) reduced intraocular pressure (IOP) by almost 33%, and lowered medication in primary open angle glaucoma cases, according to a case series published in BMC Ophthalmology. 

Researchers reviewed the cases to determine if combining phacoemulsification technique, ab-interno trabeculectomy dual blade, and ECP reduced IOP and lowered medication in primary open-angle glaucoma cases.

They looked at 27 eyes of 27 patients with uncontrolled mild to advanced primary open-angle glaucoma and cataract, all of whom had surgery at the same surgical center in Peru between April 2017 and May 2017. They measured IOP, best corrected visual acuity (BCVA) logMAR, and number of glaucoma medications at day 1, week 1, and 1, 3, 6, and 9 months postoperatively. The primary outcome measure for success was IOP lower than 14 mm Hg, either with no medications (complete success) or with medications (qualified success).

In the study, mean basal IOP was 17.0 mm Hg. Postoperatively, it was 11.6 mm Hg and 11.4 mm Hg (P <.001) at 6 and 9 months, respectively. 

They found that the combined surgeries reduced glaucoma medication from 1.9 (± 1.4) to 0.56 (± 1.05) at 9 months follow-ups (P <.001). They also found that surgical success was high: 92.6%, to be exact, with complete success measured at 70.3% and qualified success, 29.6%, all at 9 months. Preoperative best corrected visual acuity was improved from 0.4 ± 0.4 LogMAR to 0.2 ± 0.4 logMAR at 9 months.

“Cataract extraction as a stand-alone procedure does not provide a significant reduction of IOP in patients with primary open angle glaucoma, therefore a combined treatment with glaucoma surgery is almost always the choice for adequate control of the intraocular pressure,” the study explains. 

“The available evidence suggests at most a modest reduction in IOP from cataract extraction around 1.5 mm Hg to3 mm Hg possibly via decompression or mechanical stretch of the trabecular meshwork and Schlemm’s canal.”

However, further study should be conducted to compare combined surgical treatment with trabeculectomy alone.

Reference

Izquierdo JC, Mejías J, Cañola-R L, Agudelo N, Rubio B. Primary outcomes of combined cataract extraction technique with ab-interno trabeculectomy and endoscopic cyclophotocoagulation in patients with primary open angle glaucoma. BMC Ophthalmology. 2020:20(1):406. doi: 10.1186/s12886-020-01643-2.