Outcomes of Phacogoniotomy for Medically-Controlled and Uncontrolled Primary Open-Angle Glaucoma with Cataract: A Multicenter Study.

Prcis: Phacogoniotomy, a combination of phacoemulsification and intraocular lens implantation (PEI) and 120° goniotomy (GT) was an effective and safe surgical treatment for medically-controlled or uncontrolled primary open-angle glaucoma (POAG) with cataract.

Purpose: To evaluate the efficacy and safety of PEI combined with 120°GT in the treatment of medically-controlled or uncontrolled POAG with cataract.

Methods: Multicenter observational study conducted in nine ophthalmic institutes/general hospitals in China. Patients with medically-controlled (baseline intraocular pressure [IOP] >21 mmHg) or uncontrolled (baseline IOP ≤21 mmHg) POAG with clinically significant cataract were included, who were followed up with at least 12 months. The IOP, topical hypotensive medication, surgery complications, visual acuity, surgery success were recorded and compared between groups at baseline and the final visit. Complete surgical success was defined as postoperative IOP of 5-18 mmHg without additional topical medications, vision-threatening complications or reoperation for glaucoma. Qualified success is same as complete success except allowing use of ocular hypotensive medications.

Results: One hundred participants with 132 eyes were included with a mean follow-up time of 17.5±5.2 months (12 to 32) postoperatively. In general, the mean IOP reduced from 21.2±7.4 mmHg at baseline to 14.7±2.9 mmHg postoperatively (P<0.05), with an average reduction of 6.4±7.9 mmHg (23.5±25.6%). The mean number of hypotensive medications declined from 1.6±1.2 to 0.3±0.6, with a mean reduction of 1.4±1.2. One hundred and eight out of 132 (81.8%) eyes achieved complete success and 118 (89.4%) achieved qualified success of surgery, respectively. The chief complications involved hyphema (15.2%), corneal edema (19.7%), IOP spike (8.3%), or hypotony (1.5%). In subgroup analysis of medically-controlled versus medically-uncontrolled pariticpants, no difference was found in IOP at final visit (14.5±0.3 mmHg vs.15.1±0.4 mmHg; P=0.28), medication (1.8±1.1 vs. 1.4±1.3; P=0.54), as well as complete (85.3% vs. 77.2%; P=0.23) or qualified success rate (95.0% vs. 86.0%; P=0.27), nor in any kind of surgery complications (all Ps>0.05), respectively.

Conclusion: POAG with cataract could be effectively treated by phacogoniotomy, regardless of medically-controlled or medically-uncontrolled status at baseline.