Does phacoemulsification affect the long-term success of non-penetrating deep sclerectomy?

Clinical outcomes of viscocanalostomy and phacoviscocanalostomy in primary open angle glaucoma: Two years follow-up

PURPOSE

To compare the outcomes of phacoviscocanalostomy and viscocanalostomy in patients with primary open angle glaucoma.

METHODS

This non randomized, prospective comparative study included 168 eyes of 168 patients with primary open angle glaucoma (POAG). Phacoviscocanalostomy was performed in 94 eyes with POAG and cataract and viscocanalostomy was performed in 74 eyes with POAG. Preoperative and postoperative intraocular pressures (IOP), number of antiglaucoma medication, intraoperative and postoperative complications were recorded throughout the follow-up period.

RESULTS

The mean follow-up after surgery was 20.13 ± 7.9 months. Mean IOP decreased significantly 1 month after surgery in both groups (p < 0.001) and remained significantly lower from its preoperative value at all follow-up visits. The postoperative mean IOP at the last follow up in phacoviscocanalostomy and viscocanalostomy was 14.98 ± 4.8 mmHg and 16.84 ± 5.0 mmHg, respectively (p = 0.001). Complete success rate in phacoviscocanalostomy and viscocanalostomy groups was 83.1% and 56.8%, respectively (p = 0.008). Qualified success rate was achieved in 89.4% eyes in the phacoviscocanalostomy group and 83.8% of viscocanalostomy group (p = 0.534). The Best corrected visual acuity (BCVA) in phacoviscocanalostomy group improved significantly post-operatively (p = 0.001). Postoperative antiglaucoma medication in both groups were significantly less than the preoperative values (p = 0.001).

CONCLUSIONS

Both Phacoviscocanalostomy and viscocanalostmy are effective procedures in the control of IOP in patients with POAG with and without cataract. Higher complete success rates and BCVA were achieved in phacoviscocanalostomy. Therefore, phacoviscocanalostomy and viscocanalostomy are recommended in eyes with medically uncontrolled primary open-angle glaucoma with and without coexisting cataract.

Minimally Invasive Surgery in Mild-to-Moderate Glaucoma Patients in Italy: Is It Time to Change?

Medical therapy is the first treatment choice for most patients with glaucoma; however, in a relevant proportion of patients, intraocular pressure (IOP) reduction is achieved with multi-therapy and/or high therapeutic doses. Conventional surgery is the standard alternative to medical therapy when this is not effective or not tolerated. Recently, selective laser trabeculoplasty (SLT) has been advocated as first-line therapy, and "minimally invasive glaucoma surgery" (MIGS) has been developed as safer and less traumatic surgical intervention for patients with glaucoma. Schlemm's canal surgery has emerged as one of the approaches with the most favorable risk-benefit profile for glaucoma patients in need of cataract surgery. However, despite the promising results, use of MIGS in Italy has been extremely low. We aimed to investigate the reasons of the lower-than-expected use of Schlemm's canal-based MIGS devices in Italy, share our perspective on their potential place in therapy, and give practical suggestions to improve the management of glaucoma patients.

Visante Anterior Segment Optical Coherence Tomography Analysis of Morphologic Changes in the Anterior Segment Structures after Deep Sclerotomy Versus Phaco-Deep Sclerotomy with Intraoperative Mitomycin-C and No Implant Use

This article has been retracted.

[Non-penetrating glaucoma surgery]

Patients at high risk of developing complications (e.g. high myopia, aphakia, advanced visual field defects) benefit from non-penetrating glaucoma surgery (NPGS). Neovascular glaucoma, traumatic glaucoma or patients with a narrow angle (a scleral spur must at least be visible) are not suitable for NPGS. The aim of deep sclerectomy (DS) is mainly external subconjunctival drainage. Modified with mitomycin C and intrascleral implants, intraocular pressure (IOP) and success of DS are comparable to trabeculectomy. Viscocanalostomy and the further development to canaloplasty aim for blebless IOP control. Viscocanalostomy has an extremely low complication profile but only a slight reduction in IOP. Canaloplasty creates much more favourable results. Combined with phacoemulsification canaloplasty appears to lower IOP comparable to phacotrabeculectomy and demonstrates a more sustainable success compared to canaloplasty alone.