Refractive Outcomes Following Combined Cataract and Microinvasive Glaucoma Surgery

Overview

Journal Ophthalmol Glaucoma

Date 2024 Jul 14

PMID 39004220

Authors

Abdulla Shaheen

Gabriele Gallo Afflitto

Swarup S Swaminathan

Affiliations

Soon will be listed here.

Abstract

Purpose: To compare refractive outcomes in eyes undergoing cataract extraction (CE) alone, CE with goniotomy (CE/goniotomy), and CE with Schlemm's canal stent (CE/SCS) insertion.

Design: Retrospective cohort study.

Participants: Eyes from the Bascom Palmer Glaucoma Repository undergoing CE/goniotomy, CE/SCS insertion, or uncomplicated CE alone between July 2014 and February 2022 were identified.

Methods: Refraction data were analyzed at postoperative month (POM) 1 and 6 with Kruskal-Wallis and Dunn's tests. Anisometropia was defined as a spherical equivalent (SE) difference of ≥2D.

Main Outcome Measures: The primary outcome was mean refraction at POM1 and POM6 across the 3 surgical groups. Secondary outcomes were comparisons of refraction and visual acuity (VA) among different goniotomy and Schlemm's canal stent (SCS) devices, as well as incidence of anisometropia.

Results: A total of 8360 eyes (150 CE/goniotomy, 395 CE/SCS, and 7815 CE alone) from 6059 patients were analyzed. At POM1, mean SE in the CE/goniotomy, CE/SCS, and CE alone groups was -0.36 ± 0.91D, -0.31 ± 0.85D, and -0.39 ± 0.88D respectively (P = 0.019). Mean logarithm of the minimum angle of resolution VA was 0.10 ± 0.20, 0.08 ± 0.19, and 0.14 ± 0.26 respectively (P = 0.002, CE/SCS vs. CE alone). No statistically significant differences were noted at POM6. Anisometropia occurred at POM1 in 2 patients (13.3%) in the CE/goniotomy-CE group, 1 patient (3.2%) in the CE/SCS-CE group, and 184 patients (4.9%) in the CE-CE group (P = 0.217). At POM6, mean SEs were -0.38 ± 0.97D (CE/goniotomy), -0.35 ± 0.81D (CE/SCS), and -0.40 ± 0.91D (CE alone; P = 0.473). No significant differences in overall refractive outcomes were observed with different SCS or goniotomy devices. Among primary open-angle glaucoma/normal-tension glaucoma eyes, mean SE at POM1 was -0.36 ± 0.73D (CE/goniotomy), -0.24 ± 0.84D (CE/SCS), and -0.45 ± 0.81D (CE alone; P < 0.001).

Conclusions: Concurrent SCS insertion or goniotomy with CE was associated with some statistically significant differences in postoperative refraction and VA, although these small magnitude differences were unlikely to be clinically meaningful.

Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references in the Footnotes and Disclosures at the end of this article.

References

Falkenberry S, Singh I, Crane C, Haider M, Morgan M, Grenier C . Excisional goniotomy vs trabecular microbypass stent implantation: a prospective randomized clinical trial in eyes with mild to moderate open-angle glaucoma. J Cataract Refract Surg. 2020; 46(8):1165-1171. DOI: 10.1097/j.jcrs.0000000000000229. View

Ahmed I, Fea A, Au L, Ang R, Harasymowycz P, Jampel H . A Prospective Randomized Trial Comparing Hydrus and iStent Microinvasive Glaucoma Surgery Implants for Standalone Treatment of Open-Angle Glaucoma: The COMPARE Study. Ophthalmology. 2019; 127(1):52-61. DOI: 10.1016/j.ophtha.2019.04.034. View

Ahmed I, De Francesco T, Rhee D, McCabe C, Flowers B, Gazzard G . Long-term Outcomes from the HORIZON Randomized Trial for a Schlemm's Canal Microstent in Combination Cataract and Glaucoma Surgery. Ophthalmology. 2022; 129(7):742-751. DOI: 10.1016/j.ophtha.2022.02.021. View

Ioannidis A, Toteberg-Harms M, Hamann T, Hodge C . Refractive Outcomes After Trabecular Micro-Bypass Stents (iStent ) with Cataract Extraction in Open-Angle Glaucoma. Clin Ophthalmol. 2020; 14:517-524. PMC: 7044743. DOI: 10.2147/OPTH.S239103. View

Hashemi H, Pakzad R, Yekta A, Aghamirsalim M, Pakbin M, Ramin S . Global and regional prevalence of age-related cataract: a comprehensive systematic review and meta-analysis. Eye (Lond). 2020; 34(8):1357-1370. PMC: 7376226. DOI: 10.1038/s41433-020-0806-3. View

Tham Y, Li X, Wong T, Quigley H, Aung T, Cheng C . Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology. 2014; 121(11):2081-90. DOI: 10.1016/j.ophtha.2014.05.013. View

Sieck E, Capitena Young C, Epstein R, SooHoo J, Pantcheva M, Patnaik J . Refractive outcomes among glaucoma patients undergoing phacoemulsification cataract extraction with and without Kahook Dual Blade goniotomy. Eye Vis (Lond). 2019; 6:28. PMC: 6751845. DOI: 10.1186/s40662-019-0153-2. View

Hirabayashi M, Virdi G, King J, Lee D, Nguyen V, An J . Effect of Excisional Goniotomy with the Kahook Dual Blade (KDB) on Surgically Induced Astigmatism. Clin Ophthalmol. 2020; 14:4297-4303. PMC: 7733437. DOI: 10.2147/OPTH.S279073. View

. Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: the Right to Sight: an analysis for the Global Burden of Disease Study. Lancet Glob Health. 2020; 9(2):e144-e160. PMC: 7820391. DOI: 10.1016/S2214-109X(20)30489-7. View

10.

Mathew D, Buys Y . Minimally Invasive Glaucoma Surgery: A Critical Appraisal of the Literature. Annu Rev Vis Sci. 2020; 6:47-89. DOI: 10.1146/annurev-vision-121219-081737. View

11.

Scott R, Ferguson T, Stephens J, Berdahl J . Refractive outcomes after trabecular microbypass stent with cataract extraction in open-angle glaucoma. Clin Ophthalmol. 2019; 13:1331-1340. PMC: 6663082. DOI: 10.2147/OPTH.S206619. View

12.

Rho S, Lim S . Clinical Outcomes After Second-Generation Trabecular Microbypass Stents (iStent inject®) with Phacoemulsification in Korean Patients. Ophthalmol Ther. 2021; 10(4):1105-1117. PMC: 8589960. DOI: 10.1007/s40123-021-00412-8. View

13.

Quigley H, Broman A . The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol. 2006; 90(3):262-7. PMC: 1856963. DOI: 10.1136/bjo.2005.081224. View

14.

Kim M, Rho S, Lim S . Five-Year Outcomes of Single Trabecular Microbypass Stent (iStent) Implantation with Phacoemulsification in Korean Patients. Ophthalmol Ther. 2023; 12(6):3281-3294. PMC: 10640437. DOI: 10.1007/s40123-023-00824-8. View

15.

Manoharan N, Patnaik J, Bonnell L, SooHoo J, Pantcheva M, Kahook M . Refractive outcomes of phacoemulsification cataract surgery in glaucoma patients. J Cataract Refract Surg. 2018; 44(3):348-354. DOI: 10.1016/j.jcrs.2017.12.024. View

16.

Salimi A, Kassem R, Santhakumaran S, Harasymowycz P . Three-Year Outcomes of a Schlemm Canal Microstent (Hydrus Microstent) with Concomitant Phacoemulsification in Open-Angle Glaucoma. Ophthalmol Glaucoma. 2022; 6(2):137-146. DOI: 10.1016/j.ogla.2022.08.012. View

17.

Sarkisian Jr S, Radcliffe N, Harasymowycz P, Vold S, Patrianakos T, Zhang A . Visual outcomes of combined cataract surgery and minimally invasive glaucoma surgery. J Cataract Refract Surg. 2020; 46(10):1422-1432. DOI: 10.1097/j.jcrs.0000000000000317. View