One-Stage Sequential Combined Cataract And Glaucoma Surgery: Clinical Outcomes Of Micropulse Transscleral Laser Therapy Combined With Phacoemulsification

To evaluate the efficacy and safety of immediately sequential micropulse transscleral laser therapy (MPTLT) combined with phacoemulsification and intraocular lens implantation (Phaco-IOL) in patients with cataract associated with stage II–III glaucoma, and to assess early and late postoperative outcomes.

Astana Vision Clinic, Astana, Kazakhstan.

This interventional case series included 14 patients (14 eyes) with cataract complicated by stage II–III primary open-angle glaucoma (POAG) or primary angle-closure glaucoma (PACG). Baseline best-corrected distance visual acuity (BCDVA) ranged from 0.1 (1.0 LogMAR) to 0.3 (0.5 LogMAR), and intraocular pressure (IOP) ranged from 26–32 mmHg.

MPTLT was performed as the initial stage, followed by Phaco-IOL 6 hours later on the same day. Pilocarpine was administered preoperatively to prevent persistent postoperative mydriasis. Standard postoperative topical antibiotic and corticosteroid therapy was prescribed. Patients were followed for 6–12 months.

IOP reduction was achieved in 95% of cases, with gradual normalization within 3 days in a subset of patients.

Improvement in BCDVA was observed in 100% of cases, reaching 0.50–0.80 (0.3–0.1 LogMAR).

Optical coherence tomography (OCT) demonstrated increased retinal nerve fiber layer (RNFL) thickness in all cases within 1–3 months postoperatively.

Postoperative complications occurred in three cases (21.3%): one case (7.1%) of grade I exudative reaction resolved with conservative therapy; one case (7.1%) of transient ocular hypertension at 1 month requiring repeat MPTLT; and one case (7.1%) of cystoid macular edema (CME) that resolved with topical corticosteroid therapy within one month.

1. Immediately sequential MPTLT + Phaco-IOL surgeries improved visual acuity and reduced IOP;
2. Immediately sequential MPTLT + Phaco-IOL surgeries reduce overall treatment and rehabilitation time;
3. Immediately sequential MPTLT + Phaco-IOL may be associated with some complications that can occur with both traditional MIGS and combined Phaco-IOL + MIGS, but their incidence is significantly lower;
4. Long-term results are stable for 6-12 months after surgery in most cases;
5. In our opinion, in clinical cases of cataract complicated with glaucoma, immediately sequential MPTLT + Phaco-IOL treatment can be preferred surgical choice.