Outcomes of phacoemulsification and endoscopic cyclophotocoagulation performed with dual blade ab interno trabeculectomy or trabecular micro-bypass stent insertion

• Published in: Eye (London) Vol. 36; no. 2; pp. 424 - 432
• Main Authors: Klug, Emma, Chachanidze, Marika, Nirappel, Abraham, Chang, Enchi K., Hall, Nathan, Chang, Ta C., Solá-Del Valle, David
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.02.2022; Nature Publishing Group
• Subjects: 692/308/409; 692/700/565/545; Acuity; Adolescent; Endoscopy; Glaucoma; Glaucoma - surgery; Glaucoma, Open-Angle - surgery; Humans; Implants; Intraocular Pressure; Laboratory Medicine; Medicine; Medicine & Public Health; Ophthalmology; Patients; Phacoemulsification; Pharmaceutical Sciences/Technology; Retrospective Studies; Stents; Surgery; Surgical Oncology; Survival; Survival analysis; Trabeculectomy - methods; Treatment Outcome; Visual Acuity
• ISSN: 0950-222X; 1476-5454; 1476-5454
• DOI: 10.1038/s41433-021-01475-4

Background/Objective To report the initial outcomes of phacoemulsification, endoscopic cyclophotocoagulation, and dual blade ab interno trabeculectomy (PEcK), and compare them to those of phacoemulsification, endoscopic cyclophotocoagulation, and trabecular micro-bypass stent insertion (ICE-1). Subjects/Methods Patients from January 2018 to December 2019 that underwent PEcK or ICE-1 at a tertiary referral centre were included in this retrospective comparative case series. Patients were excluded if they had additional concomitant procedures, less than 6 weeks (42 days) of follow-up or were not at least 18 years old. Intraocular pressure (IOP), number of glaucoma medications, and best-corrected visual acuity were collected preoperatively and postoperatively at 6 weeks, 3, 6, and 12 months. Kaplan–Meier survival analysis and Cox proportional-hazards regression were conducted to elucidate any factors associated with survival time. Results The mean preoperative IOP was 18.3 ± 5.9 mmHg in the PEcK group (53 eyes) and 14.7 ± 4.3 mmHg in the ICE-1 group (23 eyes) ( p  = 0.004) on 3.3 ± 1.3 and 1.7 ± 0.93 glaucoma medications ( p  < 0.001), respectively. Twelve months postoperatively the mean IOP reduction was 5.1 ± 4.4 mmHg and 2.3 ± 4.0 mmHg ( p  = 0.08), and the mean medication reduction was 1.6 ± 1.5 and 0.97 ± 0.66 ( p  = 0.10), in the PEcK and ICE-1 groups, respectively. Kaplan–Meier survival analysis did not reveal any differences in treatment survival. Conclusions Both PEcK and ICE-1 provide clinically relevant reductions in IOP and glaucoma medication burden, however the PEcK procedure may confer greater reductions in IOP. The procedures did not differ with regard to Kaplan–Meier survival probability.