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Minimally invasive procedure with phaco reduces IOP, medication use in glaucoma patients
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 Brian Francis |
A minimally invasive glaucoma treatment combined with cataract extraction lowered IOP and reduced glaucoma medications, with fewer complications than trabeculectomy, according to study results.
"I think it's appropriate for controlled or uncontrolled glaucoma patients," Brian Francis, MD, said at Hawaiian Eye 2011. "I believe it's safer and has simpler follow-up and lower complication rates compared to trabeculectomy with mitomycin."
Trabectome (NeoMedix) is an outflow procedure that allows surgeons to expose Schlemm's canal through the trabecular meshwork before performing ablation. Dr. Francis said he performs the procedure before phacoemulsification to avoid corneal edema, thereby preserving the view of the angle.
About 90% of patients with cataract and open-angle glaucoma who underwent the combined procedure achieved an IOP reduction of 20% or more. At 2-years' follow-up, mean IOP was reduced from 20 mm Hg to 15 mm Hg and medication use was reduced from 2.6 to 1.5, Dr. Francis said.
In a separate nonrandomized, prospective comparative analysis, mean IOP in open-angle glaucoma patients who underwent the combined procedure was reduced from 22.2 mm Hg at baseline to 15.3 mm Hg at 2-years' follow-up. The number of medications was reduced from 2.4 to 1.5.
Patients who underwent cataract extraction alone had a lower baseline IOP of 16.2 mm Hg, but IOP was still reduced to 14.4 mm Hg at 2 years after the procedure, Dr. Francis said.
- Disclosure: Dr. Francis is a consultant for NeoMedix.
The most important finding was that combining ab interno trabeculectomy (AIT) using the Trabectome with cataract surgery resulted in a reduction of IOP and a reduction in the need for glaucoma medication. Unfortunately, the study was not a randomized, prospective, controlled clinical trial. But looking at historical controls of people who had phacoemulsification alone, you see a greater percentage reduction of IOP in those who had AIT combined with phaco, as opposed to the retrospective phacoemulsification group alone. We do need a prospective, randomized, controlled clinical trial in order to answer the question of whether AIT plus phaco is superior to phaco alone in IOP reduction, but the findings that Dr. Francis presented were encouraging.
– Joel S. Schuman, MD, FACS
OSN Glaucoma
Board member
Hawaiian Eye and Retina 2012 will be held January 15-20 at the Grand Wailea Resort & Spa in Maui. Learn more at OSNHawaiianEye.com or RetinaMeeting.com.