Two-Year Outcomes of Phacogoniotomy vs Phacotrabeculectomy for Advanced Primary Angle-Closure Glaucoma With Cataract: A Noninferiority Randomized Clinical Trial.
Song Yunhe, Fan Sujie, Tang Li, Lin Fengbin, Li Fei, Lv Aiguo, Li Xiaoyan, Wen Tingli, Lu Lan, Xiao Meichun
AI Summary
Phacogoniotomy was noninferior to phacotrabeculectomy for advanced PACG with cataract at two years regarding IOP reduction. This suggests phacogoniotomy is a viable, less invasive alternative for these patients.
Abstract
Importance
Intraocular pressure (IOP) reduction with phacogoniotomy (phacoemulsification plus goniosynechialysis plus goniotomy) was not less than that of phacotrabeculectomy for advanced primary angle-closure glaucoma (PACG) with cataract at 1-year follow-up, but longer-term outcomes are needed.
Objective
To investigate if phacogoniotomy is noninferior to phacotrabeculectomy for advanced PACG with cataract at 2 years.
Design, setting, and participants: This multicenter, noninferiority, randomized clinical trial took place in 7 ophthalmology centers in China. The trial started May 31, 2021, and 2-year follow-up ended May 31, 2024. Included in this analysis were patients with advanced PACG and cataract. Study data were analyzed from September 2024 to January 2025.
Interventions
Random assignment (1:1) to phacogoniotomy or phacotrabeculectomy.
Main outcomes and measures: The primary outcome measure was reduction in IOP from baseline to the 2-year visit with a noninferiority margin of 4 mm Hg.
Results
A total of 124 participants (124 eyes) were randomized (mean [SD] age, 66.4 [8.6] years; 67 female [54.0%]), 65 (52.4%) to the phacogoniotomy group and 59 (47.6%) to the phacotrabeculectomy group. A total of 59 patients (90.7%) in the phacogoniotomy group and 52 patients (88.1%) in the phacotrabeculectomy group completed 2-year visits. All participants were Chinese. Mean (SD) IOP reduction was -25.6 (10.2) mm Hg and -24.7 (9.4) mm Hg in the phacogoniotomy and phacotrabeculectomy groups, respectively, and the upper boundary of the CI for difference in change between groups was lower than the 4-mm Hg noninferiority margin (mean difference, -0.5 mm Hg; 97.5% CI, -1.7 mm Hg to 0.8 mm Hg; P = .42). The mean difference for complete success for phacogoniotomy vs phacotrabeculectomy was -6.7% (95% CI, -21.4% to 8.8%; P = .47) and for qualified success was 1.4% (95% CI, -11.0% to 14.3%, P = .30). Median (IQR) number of antiglaucomatous medication was 0 (0) vs 0 (0; Hodges-Lehmann estimate of location shift, 0; 95% CI, 0; P =.12) with phacogoniotomy vs phacotrabeculectomy, respectively (mean difference, 0.13; 95% CI, -0.36 to 0.63; P = .60).
Conclusions and relevance: Mean IOP reduction with phacogoniotomy was noninferior to phacotrabeculectomy for advanced PACG and cataract at 2-year follow-up with no differences detected in complete or qualified success or mean number of antiglaucomatous medications. These findings support phacogoniotomy as an alternative to phacotrabeculectomy for patients with advanced PACG and cataract.
Trial registration: ClinicalTrials.gov Identifier: NCT04878458.
MeSH Terms
Shields Classification
Key Concepts5
Phacogoniotomy (phacoemulsification plus goniosynechialysis plus goniotomy) was noninferior to phacotrabeculectomy for advanced primary angle-closure glaucoma (PACG) with cataract at 2-year follow-up, with a mean IOP reduction of -25.6 (10.2) mm Hg in the phacogoniotomy group and -24.7 (9.4) mm Hg in the phacotrabeculectomy group, and an upper boundary of the CI for difference in change between groups lower than the 4-mm Hg noninferiority margin (mean difference, -0.5 mm Hg; 97.5% CI, -1.7 mm Hg to 0.8 mm Hg; P = .42).
No significant differences were detected in complete success between phacogoniotomy and phacotrabeculectomy for advanced primary angle-closure glaucoma (PACG) with cataract at 2-year follow-up (mean difference, -6.7%; 95% CI, -21.4% to 8.8%; P = .47).
No significant differences were detected in qualified success between phacogoniotomy and phacotrabeculectomy for advanced primary angle-closure glaucoma (PACG) with cataract at 2-year follow-up (mean difference, 1.4%; 95% CI, -11.0% to 14.3%; P = .30).
No significant differences were detected in the median number of antiglaucomatous medications between phacogoniotomy and phacotrabeculectomy for advanced primary angle-closure glaucoma (PACG) with cataract at 2-year follow-up (median [IQR] 0 [0] vs 0 [0]; Hodges-Lehmann estimate of location shift, 0; 95% CI, 0; P = .12; mean difference, 0.13; 95% CI, -0.36 to 0.63; P = .60).
A multicenter, noninferiority, randomized clinical trial in 7 ophthalmology centers in China investigated if phacogoniotomy is noninferior to phacotrabeculectomy for advanced primary angle-closure glaucoma (PACG) with cataract at 2 years, randomizing 124 participants (124 eyes) with a mean (SD) age of 66.4 (8.6) years.
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