A novel method of combined phacoemulsification and vacuum trabeculoplasty ab interno

Aim. To improve the efficacy of cataract and primary open-angle glaucoma (POAG) surgery using a novel combined surgical technique.
Materials and methods. 219 patients were included in the study. According to the design, all subjects were
divided into study group (n = 58) and two control groups (n = 78 and n = 83). Combined phaco and vacuum trabeculoplasty (VTP) ab interno was performed in 58 study group patients. Pre-op and post-op, all patents had a complete eye examination including vision and hydrodynamics testing as well as anterior chamber depth (ACD) and angle assessment
using optical coherent tomography.
Results. In study group, stable IOP decrease was observed for 2‑yrs follow-up. Phacoemulsification in cataract and POAG patients has an impact on anterior segment anatomy and topography owing to significant increase of ACD by 1.2 mm and anterior chamber angle by 3.3°. VTP ab interno provides additional ACD increase by 1.8 mm and anterior chamber angle by 15.9°. Complication rate was 8.5 % in study group (i.e., following combined phaco and VTP ab interno) and 5.1 % and 8.4 % in control groups. Hospitalization days in all groups had no significant differences.
Conclusion. A novel method of combined VTP ab interno and cataract phacoemulsification provides significant IOP decrease (by 74 %) at 2‑yrs follow-up. Following VTP and phaco, fewer or even no hypotensive eye drops were required. This technique is less traumatic than traditional cataract and glaucoma surgery. Indication for combined VTP and phaco is (im) mature cataract with medically (sub) compensated POAG.

1. Shkurenko I. V., Jeskina Je. N., Rzaev V. M., Seregina S. Ju. [Safety and efficacy of single and two stage surgery of glaucoma and cataract.] Rossijskij obshhenacionalnyj oftalmologicheskij forum, 5‑j: Sbornik nauchnyh statej. [Russian national ophthalmology forum, the 5th: Collection of scientific articles]. Moscow, 2012; 150 (in Russ.).

2. Alekseev I. B. [Surgical activation of uveoscleral outflow during the cataract extraction in patients with glaucoma]. Russkij medicinskij zhurnal [Russian Medical Journal], 2005; 3: 69‑73 (in Russ.).

3. Kurysheva N. I., Maljuta G. D., Erichev V. P. [Ultrasound of the lens in patients with primary open — angle glaucoma.] Vestnik oftalmologii [Annales ophthalmology], 1997; 6: 10‑13 (in Russ.).

4. Kurysheva N. I., Fedorov A. A., Erichev V. P. [Pathological features of the front and the rear capsula of the cataract lens in patients with primary glaucoma.] Glaukoma na rubezhe tysjacheletij: itogi I perstpektivy:Sbornil statej. [Glaucoma millennium: results and prospects: Collection of articles]. Moscow, 1996;. 263‑266 (in Russ.).

5. Kuroedov A. V., Brezhnev A. Ju., Aleksandrov A. S., Ogorodnikova V. Ju. [Discussion questions of the treatment primary stage glaucoma (review]. Mezhdunarodnaja konferencija, 9‑ja Glaukoma: teorii, tendencii, tehnologii. HRT Klub Rossija: Sbornik nauchnyh statej. [International conference, the 9th Glaucoma: theories, tendencies, technologies: Collection of scientific articles]. Moscow, 2011; 174 (in Russ.).

6. BotabekovaT.K., KurmangalievaR.F., MubarakshinR.F. [Dynamic of parameters of the eye inpatient swithglaucoma after cataract extraction.] Fedorovskie chtenija: Sbornik statej. [Fedorov readings: Collection of articles]. Moscow, 2006; 91‑92 (in Russ.).

7. Sandra Johnson. Cataract Surgery in the Glaucoma Patient. Springer.; 2009: 51.

8. Baharev A. V. [A new approach for the surgical treatment combination cataract and glaucoma.] Avtoreferat kand. med. nauk. [PhD diss. (Med.Sci.) Synopsis]. Moscow, 2008 (in Russ.).

9. Tahchidi H. P., Janovskaja N. P., Frankovskaja M. [Single-stage cataract phacoemulsification with IOL implantation and microinvasive not penetrating deep sclerectomy using single sclera-limbal access.] Sovremennye tehnologii kataraktalnoj I refrakcionnoj hirurgii: Sbornik statej. [Modern technology of cataract and refractive surgery: Collection of articles]. Moscow, 2005; 289‑293 (in Russ.).

10. Anisimova S. Ju. [System approaches to the surgical treatment of open- angle glaucoma combined with cataract.] Diss. doct. med. nauk. [MD diss. (Med. Sci.)]. Moscow, 2005; 241 (in Russ.).

11. Blecher M. H. Phacotrabeculectomy with a foldable intraocular lens. CLAOJ. 1992; 3: 208‑209.

12. Maxine Lipner. [Winning combination.] Eye World Rossija. [EyeWorld Russia]. Moscow, 2013; 4: 20 (in Russ.).

13. Ivanov D. I. [Possibility of selective trabeculotomy ab interno.] Vserossijskaja nauchno-prakticheskaja konferencija s mezhdunarodnym uchastiem, 9‑ja Fedorovskie chtenija: Sbornik tezisov. [Russian scientific and practical conference with international participation Fedorov readings: Collection of abstracts]. Moscow, 2011; 305‑306 (in Russ.).

14. Alekseev I. B., Koshheeva E. A. [Method of surgical treatmet of patients with subcompensated and uncompensated glaucoma previously having fistulising operation]. Glaukoma [Glaucoma], 2007; 1: 27‑31 (in Russ.).

15. Lapochkin A. V., Neroev V. V., Lapochkin V. I. [New method of surgical treatment of primary glaucoma in eyes with cataract — enzymatic trabekuloklining. Surgical technique]. Kataraktalnaja I refrakcionnaja hirurgija [Cataract and Refractive surgery]. Moscow, 2012; 4: 23‑25 (in Russ.).

16. Jacobi PC, Krieglstein GK. Trabecular aspiration: a new surgical approach to improve trabecular facility in pseudoexfoliation glaucoma. Int Ophthalmol. 1994; 18:153‑7.

17. Theodoros Filippopoulos. [New device — Trabectome ensures safe conduct of trabeculectomy.] Novoe v oftalmologii [New in ophthalmology], 2010; 1: 53 (in Russ.).

18. Hayashi K, Hayashi H, Nakao F, Hayashi F. Effect of cataract surgery on intraocular pressure control in glaucoma patients. J Cataract Refract Surg 2001;27:1779‑1786.

19. Altan C, Bayraktar S, Altan T, Eren H, Yilmaz OF. Anterior chamber depth, iridocorneal angle width, and intraocular pressure changes after uneventful phacoemulsification in eyes without glaucoma and with open iridocorneal angles. J Cataract Refract Surg. 2004;30:832‑838.

20. Shingleton BJ, Pasternac JJ, Hung JW, O`Donoghue MW. Three and five year changes in intraocular pressures after clear corneal phacoemulsification in open angle glaucoma patients, glaucoma suspects, and normal patients. J Glaucoma 2006;15:494‑498.

21. Strenk SA, Strenk LM. In vivo MRI; visualizing the Haptics. Eye World 2007; 49‑52.

22. Poley BJ, Lindstrom RL, Samuelson TW, Schulze R Jr. Intraocular pressure reduction after phacoemulsification with intraocular lens implantation in glaucomatous and nonglaucomatous eyes. J Cataract Refract Surg 2009;35: 1946‑1955.

23. Alekseev I. B. [Cyclodialysis ab interno combined with cataract extraction in patients with glaucoma.] Vserossijskaja shkola oftalmologa, 4‑ja: Sbornik nauchnyh trudov. [Russian school of ophthalmologists, the 4th: Collection of scientific papers]. Moscow, 2005; 19‑28 (in Russ.).