Real life experience following combined excimer laser trabeculostomy and phacoemulsification in eyes with ocular hypertension or mild glaucoma and cataract

Abstract

Abstract PURPOSE: To assess the efficacy and safety of combined phacoemulsification and excimer laser trabeculostomy (ELT) in eyes with cataract and mild controlled glaucoma or ocular hypertension. METHODS: Single-centre analysis of eyes that underwent phacoemulsification and ELT between 2017 and 2021. Change in intraocular pressure (IOP), glaucoma medication requirements, corrected distance visual acuity (CDVA), complications and re-interventions were evaluated. Success was defined as a reduction ≥20% from preoperative IOP, an IOP ≤14 mmHg or a reduction in glaucoma medication requirements with an IOP equal or lower than the preoperative IOP.RESULTS: Mean follow-up was 658 ± 64 days. Mean preoperative IOP was 17.76 ± 4.88 mmHg, it decreased to 15.35 ± 3.10 mmHg at 1 year (n=37) (p = 0.006) and to 14.00 ± 3.78 at 3 years (n=8) (p = 0.074). Mean number of glaucoma medication requirements decreased from 2.02 ± 1.0 preoperatively to 1.02 ± 0.96 at 1 year (n=37) (p < 0.001) and to 1.63 ± 0.92 at 3 years (n=8) (p = 0.197). Complete success was achieved in 17.7% of eyes and qualified success in 54.8%. Two eyes of 2 patients had early postoperative hyphema. Two eyes of 1 patient underwent filtering surgery 2 months after the procedure, and 2 eyes of 1 patient underwent laser trabeculoplasty 3.8 years after the procedure due to uncontrolled IOP. CONCLUSIONS: Combined phacoemulsification and ELT is effective and safe in eyes with mild glaucoma or ocular hypertension and cataract. It significantly reduced IOP and glaucoma medication requirements 1 year after surgery.