Prospective descriptive pilot feasibility case series of low-pressure cataract surgery with the Zeiss Quatera 700 in glaucoma patients.

Abstract

Purpose: The aim of this study was to evaluate the feasibility of low-pressure cataract surgery using the Zeiss Quatera 700 system in patients with glaucoma.

Patients and methods: This is a prospective, investigator-initiated case series of 10 eyes of 10 patients with glaucoma undergoing cataract surgery with the Quatera 700. The minimal intraocular pressure (IOP) settings (30 mmHg) were used for every step of the surgery. The primary outcome was defined as the occurrence of any surgical complication. All other outcome variables were prospectively classified as secondary and exploratory endpoints. Secondary outcomes included intraoperative parameters like phaco energy usage, postoperative IOP spikes (>30 mmHg), and visual function [best-corrected visual acuity (BCVA) and visual field mean deviation (MD)].

Results: All surgeries were completed without intraoperative complications (0.0% event rate; exact 95% Clopper-Pearson CI: 0.0% to 30.8%). Mean effective phaco time was 3.24 s (± 2.01 s). Postoperative IOP spikes (>30 mmHg) occurred in two patients (20.0% event rate; exact 95% Clopper-Pearson CI: 2.5% to 55.6%) and were managed with additional acetazolamide. BCVA improved in 9 of 10 eyes (exact 95% CI: 55.5%, 99.8%). The median paired logMAR change from preoperative baseline to the 1-month postoperative follow-up was -0.10 logMAR (range: -1.30 to +0.10 logMAR, p = 0.0137), and visual field MD remained stable at 1 month postoperatively.

Conclusion: This pilot study demonstrates that low-pressure cataract surgery at a target setting of 30 mmHg using the Zeiss Quatera 700 is clinically feasible in patients with glaucoma. Given the small sample size and short follow-up of this pilot series, larger randomized comparative trials are required to confirm these preliminary safety profiles and determine long-term clinical benefits in a broader glaucoma population.