[Short- and medium-term intraocular pressure lowering effects of combined phacoemulsification and non-penetrating deep sclerectomy without scleral implant or antifibrotics]

Abstract

Purpose: To examine the short- and medium-term intraocular pressure (IOP) lowering effects of combined phacoemulsification and non-penetrating deep sclerectomy without the use of scleral implant or antifibrotics in open-angle glaucoma (primary and pseudoexfoliative) and coexisting cataract in eyes with no known risk factors for bleb failure.

Methods: Retrospective study of 15 eyes of 12 patients with medically uncontrolled open-angle glaucoma or open-angle glaucoma treated with two or more drugs and coexisting cataract with no known risk factors for glaucoma surgery failure. All patients received combined phacoemulsification and non-penetrating deep sclerectomy without scleral implant or antifibrotics performed by the same surgeon. Nd-YAG perforation of the trabeculodescemetic membrane and/or needling with mitomycin-C was performed postoperatively for IOP control. Main outcome measures were postoperative IOP, percentage of eyes with IOP < 17 mmHg, complications and final visual acuity (VA). Median follow-up was 12.0 months (SD: 0.6) and ranged from 1 to 30 months.

Results: Mean preoperative IOP with medical treatment was 21.80 mmHg (SD: 5.14) and decreased to 14.42 mmHg (SD: 2.15) at 12-month visit. Mean antiglaucoma medication preoperative was 1.93 (SD: 0.70) and was reduced to 0.13 (DE: 0.35) postoperative. At 12-month visit, 80% had an IOP lower than 17 mmHg with a mean VA gain of 2.50 Snellen lines. Conjuntival wound leakage was the most frequent complication (20%; 3/15).

Conclusions: Primary combined phacoemulsification and non-penetrating deep sclerectomy without collagen implant or antifibrotics in primary open-angle glaucoma with coexisting cataract, significantly lowers IOP in the short- and medium term in low-risk cases for glaucoma surgery failure, allowing for rapid visual improvement with a low complication rate.