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By Ana Hidalgo-Simón MD, PhD

NICE - Good results are achieved with combined glaucoma non-penetrating deep sclerectomy and phacoemulsification, according to the results of a new prospective Italian study presented at the XX ESCRS Congress.
Researchers at the University of Modena conducted a prospective study to evaluate IOP control in patients who were operated on for glaucoma and cataracts at the same time.

The study enrolled 45 patients, all with glaucoma and cataracts with a visual acuity of
0.4 or less. The trial included patients with an uncontrolled IOP despite maximum medication or patients with advanced glaucomatous damage despite being on two or three medications.

At the two-year follow-up point, most patients still had clear vision and controlled IOP, Martini Enrico MD reported.
The average preoperative uncontrolled IOP was 23.2 mm Hg. One month after the operation, IOP was 14.7 mm Hg and at six months it was 14.9 mm Hg. At one year, the average IOP had increased to 15.5 mm Hg and 16.1 mm Hg after two years.

At the end of the two-year study period, 80% of the procedures were considered complete successes with IOP levels remaining under 18 mm Hg without therapy.
In another four eyes, it was possible to maintain IOP below 18 mm Hg with the help of drug therapy, bringing to 90% the cases that could be considered qualified successes. Four eyes were failures, insofar as IOP was not kept under 18 mm Hg even with drug therapy.

Seven eyes (17.5%) required YAG goniopuncture and another five (12.5%) received 5 FU injections. Macroperforations were very rare.
Two of the 45 eyes included in the study were converted to trabeculectomy during surgery. Iris prolapse was the most common postoperative complication, he reported.

The surgical technique used was a two-site procedure with temporal phacoemulsification and foldable IOL implantation for cataract removal and non-penetrating deep sclerectomy without the use of anti-mitotic drugs for glaucoma correction. Peribulbar anaesthesia was used in all cases.

"When compared to other methods, combined phacosclerectomy shows similar results in visual acuity but achieves a better IOP control and survival rate of the filtration bleb.
"The success at two years is very satisfactory, even if there is a tendency towards increased mean IOP. We feel this technique may be considered the first choice for combined cataract and glaucoma surgery," he noted.

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