Outcomes of Phacogoniotomy for Medically Controlled and Uncontrolled Primary Open Angle Glaucoma With Cataract: A Multicenter Study.

Précis: Phacogoniotomy, a combination of phacoemulsification and intraocular lens implantation (PEI) and 120-degree goniotomy (GT), was an effective and safe surgical treatment for medically controlled or uncontrolled primary open angle glaucoma (POAG) with cataract.

Purpose

To evaluate the efficacy and safety of PEI combined with 120-degree GT in the treatment of medically controlled or uncontrolled POAG with cataract.

Methods

Multicenter observational study conducted in 9 ophthalmic institutes/general hospitals in China. Patients with medically controlled [baseline intraocular pressure (IOP) ≤21 mmHg] or uncontrolled (baseline IOP > 21 mmHg) POAG with clinically significant cataract were included, who were followed up with at least 12 months. The IOP, topical hypotensive medication, surgery complications, visual acuity, surgery success were recorded and compared between groups at baseline and the final visit. Complete surgical success was defined as postoperative IOP of 5-18 mmHg without additional topical medications, vision-threatening complications or reoperation for glaucoma. Qualified success is same as complete success except allowing use of ocular hypotensive medications.

Results

One hundred participants with 132 eyes were included with a mean follow-up time of 17.5±5.2 months ( range:12-32) postoperatively. In general, the mean IOP reduced from 21.2±7.4 mmHg at baseline to 14.7±2.9 mmHg postoperatively ( P <0.05), with an average reduction of 6.4±7.9 mmHg (23.5±25.6%). The mean number of hypotensive medications declined from 1.6±1.2 to 0.3±0.6, with a mean reduction of 1.4±1.2. One hundred eight out of 132 (81.8%) eyes achieved complete success and 118 (89.4%) achieved qualified success of surgery, respectively. The chief complications involved hyphema (15.2%), corneal edema (19.7%), IOP spike (8.3%), or hypotony (1.5%). In subgroup analysis of medically controlled versus medically uncontrolled pariticpants, difference was found neither in IOP at final visit (14.5±0.3 vs. 15.1±0.4 mmHg; P =0.28), medication (1.8±1.1 vs. 1.4±1.3; P =0.54), and complete (85.3% vs. 77.2%; P =0.23) or qualified success rate (95.0% vs. 86.0%; P =0.27), nor in any kind of surgery complications (all P s>0.05), respectively.

Conclusion

POAG with cataract could be effectively treated by phacogoniotomy, regardless of medically controlled or medically uncontrolled status at baseline.