Long-term treatment success and safety of combined phacoemulsification plus excimer laser trabeculostomy: an 8-year follow-up study

• Published in: Graefe's archive for clinical and experimental ophthalmology Vol. 260; no. 5; pp. 1611 - 1621
• Main Authors: Riesen, Maik, Funk, Jens, Töteberg-Harms, Marc
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.05.2022; Springer Nature B.V
• Subjects: Acuity; Cataract - complications; Cataracts; Complications; Diagnosis; Eye; Follow-Up Studies; Glaucoma; Humans; Intraocular Pressure; Lasers, Excimer - therapeutic use; Medicine; Medicine & Public Health; Ophthalmology; Patients; Phacoemulsification - methods; Postoperative; Postoperative Complications - epidemiology; Postoperative Complications - surgery; Success; Surgery; Trabeculectomy - methods; Treatment Outcome; Glaucoma; Excimer laser trabeculotomy; Excimer laser trabeculostomy; Phacoemulsification; ELT; MIGS
• ISSN: 0721-832X; 1435-702X
• DOI: 10.1007/s00417-021-05510-8

Purpose Combined phacoemulsification plus excimer laser trabeculostomy (phaco-ELT) is a minimally invasive surgery that effectively reduces intraocular pressure (IOP) in patients with glaucoma and a concomitant diagnosis of cataract. The aim of this study was to evaluate the long-term treatment success as well as safety of phaco-ELT over an 8-year follow-up period. Methods Patients with a diagnosis of primary or secondary glaucoma or ocular hypertension and a visually significant cataract who underwent a combined phaco-ELT between January 1, 2008, and December 31, 2010, were included. Data for IOP, the number of IOP-lowering medications (meds), best-corrected visual acuity, complications, and subsequent surgeries to lower IOP were collected preoperatively (baseline) and intraoperatively as well as at 1 day, 1 week, 1 month, 3 months, 6 months, 9 months, 1 year, and every 6 months thereafter to 8 years postoperatively. Results One hundred sixty-one eyes of 128 patients were included. After 8 years of follow-up, the long-term treatment success rate with IOP ≤ 21 mmHg was 50.2%. No serious intra- or postoperative complications occurred. The mean IOP decreased significantly from 19.3 (±4.8) mmHg at baseline to 15.4 (±3.2, p =0.0040) mmHg at 8 years. Additionally, meds remained below baseline after 8 years of follow-up and were reduced significantly for up to 4 years. Only 25.5% of the eyes required a subsequent surgery to lower IOP during the follow-up period. Conclusion Combined phaco-ELT is a safe procedure without serious intra- or postoperative complications, which has a positive long-term effect regarding IOP and meds. Remarkably, the mean IOP-lowering effect remained stable and was reduced ≥ 20% from baseline after 3 months for the remainder of the follow-up duration, whereas the number of meds was reduced significantly for up to 4 years. Furthermore, only 25.5% of the eyes required a subsequent surgery to control IOP throughout the whole follow-up of 8 years.