Combined phaco, trabeculotomy method shows positive results, study finds

Performing combined phacoemulsification and trabeculotomy by the internal approach reduced IOP and medication use in the majority of patients, according to results from a study.

Brian A. Francis, MD, MS, and colleagues evaluated IOP, glaucoma medication use and complications after performing combined phaco and trabeculotomy with a Trabectome (NeoMedix) on 304 consecutive eyes with open-angle glaucoma and cataract.

"Complications were minimal and comparable to those in an earlier series of Trabectome-only procedures," the study authors said.

The Trabectome device allows the opening of a direct pathway for aqueous to flow from the anterior chamber into Schlemm's canal collector channels.

"Under gonioscopic control, bipolar cautery was applied by a purpose-designed footplate to ablate the trabecular meshwork and inner wall of Schlemm canal," the authors said.

IOP averaged 20 mm Hg at baseline, 14.8 mm Hg at 6 months and 15.5 mm Hg at 1 year.

The investigators reported a corresponding drop in glaucoma medications from 2.65 at baseline to 1.76 at 6 months and 1.44 at 1 year.

Subsequent secondary glaucoma procedures were performed in nine patients.

Blood reflux, which occurred in 239 patients (78.4%) and was resolved within a few days, was the only frequent complication, according to the large, prospective, multicenter, interventional study, published in the July issue of Journal of Cataract & Refractive Surgery.