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IOP-lowering efficacy of combined phacoemulsification cataract extraction with intraocular lens implantation plus excimer laser trabeculotomy vs plus ab interno trabeculectomy with the Trabectome®

Poster Details

First Author: L.Jozic GERMANY

Co Author(s):    J. Magner   J. Funk   M. Toeteberg-Harms              

Abstract Details


The aim of this prospective case-controlled comparative study was to compare the IOP lowering efficacy of these two Minimally-Invasive Glaucoma Surgery (MIGS) procedures in combination with Cataract-Extraction.


The surgeries have been performed at the Eye Clinic Parkklinik Manhagen, Sieker Landstrasse 19, 22927 Großhansdorf, Germany. Data analysis and statistics have been conducted at the UniversityHospital Zurich, Department of Ophthalmology, Frauenklinikstrasse 24, 8091 Zurich, Switzerland.


Inclusion criterion was diagnosis of mild and moderate open-angle glaucoma or ocular hypertension with coexisting and visual impairing of cataract. Only one eye of each patient was included, if both eyes underwent the procedure, one eye was chosen randomly. Eyes underwent either phacoemulsification cataract-extraction with intraocular lens implantation combined with excimer laser trabeculotomy (phaco-ELT) or combined with ab interno trabeculectomy with the Trabectome (phaco-AIT). Primary outcome measures were IOP, number of hypotensive medications (AGD), and Kaplan-Meier survival. Definition of failure was IOP >21mmHg or <20% reduction of IOP below baseline, hypotony (IOP ≤5mmHg), or loss of light perception vision.


105 eyes underwent Phaco-ELT (58 right eyes) and 102 phaco-AIT (54 right eyes, P=0.375). Mean age was 74.8±6.0 in the phaco-ELT and 74.3±4.9 years in the phaco-AIT group (P=0.271). IOP was 17.8±4.3mmHg (AGD 1.4±0.7) in the phaco-ELT and 19.3±4.6mmHg (1.3±0.8) in the phaco-AIT group and decreased by -4.3±5.6mmHg (ΔAGD -0.9±0.8) and -4.3±5.6mmHg (ΔAGD -0.8±0.7), respectively. The decrease in IOP&AGD from baseline to 1year within each group were significant (P<0.005) but there was no difference between the two groups (P>0.05). The mean time to failure was 20.6±1.0months in the phaco-ELT and 12.9±0.6months in the phaco-AITgroup (P<0.001).


Phaco-ELT and phaco-Trabectome are two commonly performed MIGS procedures and reasonable considerations in mild and moderate glaucoma and ocular hypertension with a coexisting diagnosis of cataract. Both increase trabecular outflow by removing juxtacanallicular trabecular meshwork (TM) and inner wall of Schlemm’s canal. The Trabectome is a cautery device, which produces heat while removing TM. Contrary, ELT uses a non-thermal excimer laser. Thus, it is expectable that the Trabectome procedures induces more scaring compared to ELT. More scarring results in a significantly shorter mean time to failure in the phaco-AIT group. Phaco-ELT seems to have better long-term survival than phaco-AIT.

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