ESCRS - POGAU081 - Comparative Study Of Three Different Early Surgical Approaches To Lower Intraocular Pressure In Patients With Pseudoexfoliation

Comparative Study Of Three Different Early Surgical Approaches To Lower Intraocular Pressure In Patients With Pseudoexfoliation

Published 2026 - 44th Congress of the ESCRS

Reference: POGAU081 | Type: Free paper | DOI: 10.82333/xk8q-c334

Authors: Dr Ignacio Rodriguez-Una* 1 , Maria E. Simancas 2 , Andres Fernandez-Vega-Cueto 2 , Belen Alfonso-Bartolozzi 2 , Pedro P. Rodriguez-Calvo 2

1Fernandez-Vega Ophthalmological Institute,Oviedo,Spain;Fundacion de Investigacion Oftalmologica,Oviedo,Spain, 2Fernandez-Vega Ophthalmological Institute,Oviedo,Spain

Purpose

To assess and compare the short-term outcomes of stand-alone phacoemulsification (phaco), phaco-iStent inject® and phaco-Goniowash on intraocular pressure (IOP) and hypotensive medication status of patients with pseudoexfoliation (PXF).

Setting

Fernandez-Vega Institute, Spain.

Methods

Retrospective study that included patients with asymmetric pseudoexfoliative glaucoma (PXFG) or pseudoexfoliative syndrome (PXFS), who underwent cataract surgery, whether combined or not with iStent/Goniowash, between 2022 and 2025 (minimum follow-up: 1 year). Patients with prior laser trabeculoplasty were not included. IOP, number of topical hypotensive drugs, intraoperative and postoperative complications, and the requirement of further glaucoma surgery/laser were assessed.

Results

56 eyes of 56 patients (age: 73.2±6.4 years) were included (48% PXFG; 52% PXFS): stand-alone phaco (16 eyes), phaco-iStent (23 eyes), and phaco-Goniowash (17 eyes). IOP reduced from 14.9±3.2 mmHg pre- to 13.4±2.0 mmHg post-operatively (p=0.04) with phaco (-10%); from 19.3±3.8 mmHg to 16.3±5.7 mmHg (p=0.03) with iStent (-16% ); and from 15.8±2.5 mmHg to 13.2±1.2 mmHg (p<0.01) with Goniowash (-16%). Number of hypotensive medications dropped from 1.4±0.8 to 0.9±0.9 (-36%) (p = 0.04) with phaco (drop-free rate: 41%); from 2.2±0.7 to 0.6±0.8 (-73%) (p < 0.01) with iStent (drop-free rate: 63%). The 5 patients on medication in the Goniowash group became drop-free. No complications were found. 1 case (iStent) required further glaucoma surgery.

Conclusions

In early stages of PXF disease, the three presented options significantly reduced IOP and hypotensive medications, with a very good safety profile. IOP reduction was higher after phaco-iStent and phaco-Goniowash compared to stand-alone phaco. The phaco-iStent group presented higher rates of IOP reduction, with a higher proportion of dropfree patients.