Twelve-Month Outcomes of Combined Phacoemulsification with Ab Interno Canaloplasty Versus Single-Use Dual Blade Goniotomy in Glaucoma Patients

Abstract

Background To compare the efficacy and safety of combined phacoemulsification with ab interno canaloplasty (Phaco-AbiC) versus single-use dual blade goniotomy (Phaco-DBG).

Material and Methods In this prospective consecutive case series, intraocular pressure (IOP), the number of IOP-lowering medications, the mean deviation (MD) of visual field testing, and surgery-related complications were evaluated in 25 eyes following Phaco-AbiC and 20 eyes following Phaco-DBG through 12 months of follow-up. Qualified or complete success was defined as postoperative IOP lower than 21, 18, and 16 mmHg with or without IOP-lowering medications.

Results At the 12-month follow-up, IOP was significantly reduced compared to baseline in the Phaco-AbiC (14.2 ± 2.7 versus 19.2 ± 4.7 mmHg, p < 0.001) and Phaco-DBG groups (16.7 ± 3.4 versus 19.9 ± 3.9 mmHg, p < 0.001). At the 12-month follow-up, IOP was significantly higher following Phaco-DBG than Phaco-AbiC (p = 0.011). Compared to baseline, the number of IOP-lowering medications was significantly reduced in the Phaco-AbiC (1.2 ± 1.4 versus 2.4 ± 1.0, p < 0.001) and Phaco-DBG groups (0.8 ± 0.9 versus 2.1 ± 0.9, p < 0.001) at the 12-month follow-up. For IOP lower than 16 mmHg, the complete and qualified success rate was significantly higher following Phaco-AbiC (36.0 and 76.2%, respectively) than Phaco-DBG (17.5 and 40.6%; p = 0.037; p = 0.007, respectively). No severe intra- or postoperative complications occurred.

Conclusion Both Phaco-AbiC and Phaco-DBG achieved a significant reduction in IOP and IOP-lowering medications at the 12-month follow-up. IOP was significantly lower 12 months following Phaco-AbiC than Phaco-DBG.

Zusammenfassung

Hintergrund Vergleich der Wirksamkeit und Sicherheit der kombinierten Phakoemulsifikation mit Ab-interno-Kanaloplastik (Phaco-AbiC) und Dual-Blade-Goniotomie (Phaco-DBG).

Material und Methoden Der Intraokulardruck (IOD), die Anzahl der IOD-senkenden Medikamente, die mittlere Abweichung (MD) der Gesichtsfelduntersuchungen und Komplikationen wurden in dieser prospektiven, konsekutiven Fallserie bei 25 Augen nach Phaco-AbiC und 20 Augen nach Phaco-DBG während der 12-monatigen Nachbeobachtungszeit untersucht. Relativer oder vollständiger Erfolg wurde definiert als ein postoperativer IOD von weniger als 21, 18 und 16 mmHg mit bzw. ohne IOD-senkenden Medikamenten.

Ergebnisse Nach 12 Monaten war der IOD im Vergleich zum Ausgangswert in der Phaco-AbiC- (14,2 ± 2,7 vs. 19,2 ± 4,7 mmHg; p < 0,001) und der Phaco-DBG-Gruppe (16,7 ± 3,4 vs. 19,9 ± 3,9 mmHg; p < 0,001) signifikant reduziert. Der IOD war 12 Monate nach Phaco-DBG signifikant höher als nach Phaco-AbiC (p = 0,011). Im Vergleich zum Ausgangswert war die Anzahl der IOD-senkenden Medikamente in der Phaco-AbiC-Gruppe (1,2 ± 1,4 gegenüber 2,4 ± 1,0; p < 0,001) und in der Phaco-DBG-Gruppe (0,8 ± 0,9 gegenüber 2,1 ± 0,9; p < 0,001) bei der 12-Monats-Nachbeobachtung signifikant reduziert. Bei einem IOD unter 16 mmHg war die vollständige und relative Erfolgsrate nach Phaco-AbiC (36.0%, 76.2%) signifikant höher als nach Phaco-DBG (17,5%, 40,6%; p = 0,037; p = 0,007). Es traten keine relevanten intra- oder postoperativen Komplikationen auf.

Schlussfolgerungen Sowohl Phaco-AbiC als auch Phaco-DBG bewirkten eine signifikante Senkung des IOD und der IOD-senkenden Medikamente bei der 12-monatigen Nachuntersuchung. Der IOD war 12 Monate nach Phaco-AbiC signifikant niedriger als nach Phaco-DBG.

Conclusion Box

Already known:

• Phaco-AbiC and Phaco-DBG are minimally invasive surgical procedures that effectively lower IOP in glaucoma patients. To date, it remains unclear which procedure, Phaco-AbiC or Phaco-DBG, is more effective.

Newly described:

• For IOP ≤ 16 mmHg, complete and qualified success rates were significantly higher following Phaco-AbiC compared to Phaco-DBG.

• At the 12-month follow-up, IOP was significantly lower in the Phaco-AbiC than in the Phaco-DBG group.

• Both Phaco-AbiC and Phaco-DBG demonstrated safe risk profiles.

Keywords

glaucoma - canaloplasty - goniotomy - MIGS - phacoemulsification

Schlüsselwörter

Glaukom - Kanaloplastik - Goniotomie - MIGS - Phakoemulsifikation

Publication History

Received: 04 August 2024

Accepted: 24 December 2024

Article published online:
27 February 2025

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