Phaco plus MIGS helps improve quality of life, prevent visual field loss
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BOSTON — Phacoemulsification plus minimally invasive glaucoma surgery improves quality of life and prevents visual field loss in patients with glaucoma, according to a speaker.
At the American Society of Cataract and Refractive Surgery meeting, Steven R. Sarkisian Jr., MD, said it has been known for a long time, even before the phacoemulsification era, that cataract surgery lowers IOP.
“But now that we’re in the MIGS space, the MIGS era, there’s a growing consensus — it’s an overwhelming consensus — that phaco-MIGS is preferred to phaco alone in primary open-angle glaucoma,” he said.
Sarkisian shared data on several current MIGS devices used in combination with cataract surgery.
In a study of phaco plus Hydrus (Alcon), 49.5% of eyes that underwent combination therapy achieved an IOP of 18 mm Hg or less without medication compared with 33.8% of eyes that underwent cataract surgery alone.
In another study, 72% of eyes that underwent phaco plus the first-generation iStent (Glaukos) achieved unmedicated IOP of less than 21 mm Hg compared with 50% of control eyes.
While phaco plus MIGS helps lower IOP, it also has a sustained effect. Although phaco alone might be able to help lower IOP initially, the effect does not last.
“If you’re going to get a person through the rest of their life, phaco alone is not going to get them there,” Sarkisian said.
Sarkisian said the benefit that phaco plus MIGS brings to a patient’s quality of life, as well as the potential to prevent visual field loss, makes it an easy choice over phaco alone.
“In patients with treatable ocular hypertension and mild to moderate primary open-angle glaucoma, recommending phaco without offering MIGS is indefensible,” he said.
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Sarkisian SR. Phaco vs phaco plus MIGS for early to moderate glaucoma: Where’s the data? Presented at: American Society of Cataract and Refractive Surgery meeting; April 5-8, 2024; Boston.
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