Long Term Results With High Frequency Deep Sclerotomy Combined With Phacoemulsification, In The Treatment Of Open Angle Glaucoma. 5-Year Follow-Up

During the last 50 years, the management of glaucoma consists of pharmacological treatment, and if this is not enough, trabeculectomy surgeries or device implantation should be used, with  relatively high rates of complications, related to ocular hypotonia.

This situation forced the search for new surgical techniques to reduce the intraocular pressure.

High-frequency deep sclerotomy is a surgical technique performed with the Abee Glaucoma Tip, developed by the company Oertli (Oertli Instrumente AG), connected to its phacoemulsification equipment, and by high frequency, allows to ablated tissue  in the angle.

This technique is within the family of minimally invasive glaucoma surgeries (MIGS).

this is a retrospective study  analyzing the patients who underwent phacoemulsification surgery combined with high-frequency deep sclerotomy in the Glaucoma and Cataract service of the Clínica de Ojos Norte, between January 2017 and January 2020. 

36 eyes were operated with diagnosis of open-angle glaucoma (primary open-angle glaucoma and glaucoma secondary to pseudoexfoliation sindrom), the patients were between 55 and 80 years old and all were diagnosed with open-angle glaucoma under treatment. All surgeries were performed by the same surgeon, following the lens phacoemulsification plan with the Oertli Faros equipment, foldable intraocular lens implantation, and high-frequency 6-pocket deep sclerotomy in the angle of the anterior chamber with the Abee tip connected. to the phacoemulsification machine.

In the postoperative control at 6 months, the patients presented a reduction in IOP to 15.1 mmHg on average (33.77%) in relation to the 22.8 average basal IOP. In the following controls, the IOP decreased to 14.3 mmHg (37.28%) at one year, 14 mmHg (38.59%) at two years, 14.4 at 3 years (36.66), and 14.66 (36.84%)at 4 years of control. At 5 years, they maintain acceptable intraocular pressure values ​​with an average of 15.36 mmHg (32.63%).

 Drug use was also reduced from 1.38% to 0.28%, with only 8 patients using a prostaglandin analogue, and one eye using a fixed combination of Timolol-Dorzolamide BID to maintain their pressure at the target pressure value set in their respective case.

High-frequency Deep Sclerotomy (HFDS) is an effective, safe, and reproducible technology in patients operated on for cataracts with phacoemulsification combined with the diagnosis of open-angle glaucoma. Its long-term effectiveness is being considered in studies with longer follow-up, and the possibility of using it in patients with angle-closure glaucoma and cataracts is under discussion, in whom cataract surgery alone allows opening the angle and obtaining a reduction in intraocular pressure