Comparison of effectiveness and complications in trabeculotomy with phacoemulsification between ab externo and ab interno using a spatula-shaped microhook

Effects of reduction in intraocular pressure after trabeculotomy on axial length and intraocular lens selection

PURPOSE

To investigate the relationship between intraocular pressure (IOP) and axial length (AL) and to compare the refractive predicted error in patients who have undergone cataract surgery alone or in combination with trabeculotomy.

SETTING

Hospital.

DESIGN

Single-center, retrospective, case-control.

METHODS

The medical records of patients who had undergone cataract surgery alone or in combination with trabeculotomy using the Tanito microhook were retrospectively reviewed. Patients were grouped into cataract surgery alone (CAT) or cataract surgery combined with trabeculotomy (LOT) groups. Demographic data, preoperative and postoperative IOP and AL, and surgically induced astigmatism (SIA) were analyzed before and 1 month postoperatively to evaluate the interplay between IOP, AL, and refractive outcomes.

RESULTS

52 eyes (52 patients) underwent LOT, and 67 eyes (67 patients) underwent CAT. The mean IOP at baseline did not differ between the groups; the change in IOP (dIOP) was significantly higher in the LOT group than in the CAT group. The mean AL at baseline and the change in AL (dAL) were 24.0 ± 1.2 mm and 0.16 ± 0.11 mm, respectively, in the LOT group, and 23.8 ± 1.1 mm and 0.11 ± 0.070 mm, respectively, in the CAT group. The difference in dAL was also significant. In the LOT group, dIOP and dAL were significantly correlated. The mean SIA vectors did not significantly differ between the groups.

CONCLUSIONS

AL decreased because of the reduction in IOP after cataract surgery combined with trabeculotomy. Consequently, the refractive target error was greater, and the postoperative refractive outcome showed a tendency toward hyperopia.

The effect of axial length on the short-term outcomes of cataract surgery combined with ab interno trabeculotomy

PURPOSE

Minimally invasive glaucoma surgery is safer and effective surgical modality for patients with glaucoma. To compare the effect of axial length (AL) on the surgical outcomes of combined cataract surgery and ab interno trabeculotomy (phaco-LOT), a retrospective, non-randomized comparative study was performed.

METHODS

In total, 458 eyes of 458 open-angle glaucoma patients who underwent phaco-LOT and were followed-up without any intervention for at least 6 months were enrolled. All were divided into a long-AL group (AL ≥ 26.0 mm, 123 eyes) and a not-long-AL group (AL < 26.0 mm, 335 eyes). The principal outcomes were the changes in intraocular pressure (IOP) and medication scores. We also sought a correlation between postoperative IOP spike and hyphema.

RESULTS

Significant postoperative reductions in IOP and medication scores were apparent in all subjects. The IOP reductions were significant at all timepoints in the not-long-AL group, but not until 1 month postoperatively in the long-AL group, and the IOP change was significantly lower in the long-AL group from postoperative day 1 to 3 months. On subanalysis of subjects by age, the microhook used, the pre-operative IOP, and the medication score, a significantly higher incidence of IOP spike was observed in the long-AL group in weeks 1 and 2 (both p < 0.05), but this did not correlate with hyphema status, implying that a different mechanism was in play.

CONCLUSION

Phaco-LOT was effective regardless of AL, but the postoperative IOP decrease was lower and the early postoperative incidence of IOP spike was higher in long-AL eyes.

Clinical Outcomes of Phacoemulsification in Japanese Patients Receiving First and Revised Second-Generation Trabecular Microbypass Stents

PURPOSE

This study evaluated the effectiveness and safety of first and revised second-generation trabecular microbypass stent insertion [iStent (IS) and iStent inject W (IW)] in cataract surgery.

DESIGN

Single-center, retrospective, cohort study.

METHODS

The study included 176 eyes that received trabecular microbypass stents combined with cataract surgery at the Saitama Red Cross Hospital between September 2017 and September 2021. Patients were divided into IS and IW groups depending on the implant type. Demographic characteristics, intraocular pressure (IOP), and the number of antiglaucoma medications (Med) were analyzed preoperatively and 12 months postoperatively. In addition, postoperative complications were compared between the groups.

RESULTS

IS and IW were implanted in 86 eyes and 90 eyes, respectively. IOP and Med at 1, 3, 6, 9, and 12 months decreased significantly from baseline in both groups ( P = 0.04, P < 0.001, P < 0.001, P < 0.001, and P < 0.001, respectively, for IOP in the IS group; P = 0.02, P < 0.001, P < 0.001, P < 0.001, and P < 0.001, respectively, for IOP in the IW group; P = 0.03, P = 0.002, P < 0.001, P < 0.001, and P < 0.001, respectively, for Med in the IS group; and P < 0.001 for all time points for Med in the IW group). IOP did not vary significantly between the groups at 1, 3, 6, 9, and 12 months postoperatively. Med was significantly lower in IW than IS at 1, 3, 6, 9, and 12 months postoperatively ( P < 0.001, P < 0.001, P = 0.002, P = 0.002, and P = 0.002, respectively). Hyphema and IOP >30 mm Hg (spike) occurred in 1.2% and 4.4%, and 1.2% and 3.3% of patients in the IS and IW groups, respectively. The probability of successful discontinuation of medications at 12 months postoperatively was 10.5% and 41.1%, respectively ( P < 0.001).

CONCLUSIONS

Postoperative Med was significantly lower in the IW group. Simultaneous insertion of IW in patients with glaucoma requiring cataract surgery may be preferred to IS because it reduces the burden of Med.

A Comprehensive Review of Pediatric Glaucoma Following Cataract Surgery and Progress in Treatment

Glaucoma following cataract surgery (GFCS) remains a serious postoperative complication of pediatric cataract surgery. Various risk factors, including age at lensectomy, intraocular lens implantation, posterior capsule status, associated ocular/systemic anomaly, additional intraocular surgery, and a family history of congenital cataract and GFCS, have been reported. However, the optimal surgical approach remains unclear. This review evaluates the diagnostic criteria, classification, risk factors, mechanism, and surgical management, especially the efficacy of minimally invasive glaucoma surgery, in GFCS, and aims to propose an optimal clinical management strategy for GFCS. The results of our review indicate that ab interno trabeculotomy (goniotomy) may be the most appropriate first-line treatment for GFCS.