Combining cataract surgery with minimally invasive MIGS leads to more efficient IOP lowering and reduced need for medications than phacoemulsification alone, according to a study.
Of the two combined procedures used in the comparison, phaco with excimer laser trabeculotomy (phaco-ELT) had a longer survival time than phaco with ab interno trabeculotomy (phaco-aiT) with the Trabectome (MicroSurgical Technology, formerly NeoMedix).
ELT and aiT are two ab interno MIGS procedures that target the trabecular meshwork outflow pathway. The first creates microperforations in the trabecular meshwork by introducing a laser probe into the anterior chamber, while the second uses the electrode tip of the Trabectome. Both procedures were performed in the study after phacoemulsification and IOL implantation.
The charts of patients who underwent either phacoemulsification alone or one of the two combined procedures between 2007 and 2012 were retrospectively reviewed. A total of 245 eyes of 245 subjects were included, all operated on by the same surgeon.
All three procedures lowered IOP and reduced medications, but combined surgery was significantly more effective. A 1.5 mm Hg IOP reduction was obtained in the phaco-alone group as compared with a reduction of 4.3 mm Hg in the phaco-ELT group and 5.3 mm Hg in the phaco-aiT group. The mean number of medications was significantly reduced in both the combined procedure groups and nonsignificantly reduced in the phaco-alone group.
Phaco-ELT showed an advantage over phaco-aiT in the long term, with a significantly longer survival time of 20.6 months vs. 12.9 months. According to the authors, “this might be based on the nonthermal principal of ELT, which to our knowledge so far does not induce significant scarring, and distinguishes ELT from aiT.”
They noted that the two combined procedures effectively lowered IOP below the mid-teens, which makes them suitable treatment options for mild to moderate glaucomas and ocular hypertension.
However, “the longer survival time of the combined ELT technique may support an implant-free, nonthermal approach over other techniques,” the authors said. – by Michela Cimberle
Disclosures: Jozic reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.