Results of combined phacoemulsification and viscocanalostomy in patients with cataract and pseudoexfoliative glaucoma

PURPOSE. Coexisting pseudoexfoliation glaucoma (PEXG) and cataract represents a special challenge. Although phacotrabeculectomy is an effective procedure, it combines the risks of phacoemulsification and trabeculectomy. This study evaluates phacoviscocanalostomy to manage eyes with PEXG and cataract. METHODS. We conducted a prospective noncomparative study that included 30 consecutive eyes of 22 patients with uncontrolled PEXG and cataract. Phacoviscocanalostomy was performed in all. Success rate based on postoperative intraocular pressure (IOP) reduction and requirement for topical antiglaucoma medication was evaluated as the main outcome measure. Visual acuity and complication rates were secondary outcomes. RESULTS. The mean follow-up was 18.6 months +/- 6.2 (SD) (range 12 to 36 months). There was statistically significant decrease in mean IOP from 25.3 +/- 5.2 mmHg preoperatively to 13.5 +/- 6.0 mmHg 1 day after surgery (p<.05), 12.3 +/- 3.1 mmHg at the final follow-up (p<.05), and at all evaluations to the last postoperative visit. Only three eyes (10%) required a single antiglaucoma medication to achieve the target IOP. A complete surgical success (IOP < 21 mmHg without medication) was achieved in 90%, while a qualified success (IOP < 21 mmHg with or without glaucoma medication) was achieved in 100% of cases. Complications included Descemet membrane microperforations (13.3%), macroperforation (3.3%), zonular dehiscence (6.6%), and transient postoperative IOP spike (3.3%). CONCLUSIONS. Phacoviscocanalostomy achieved excellent IOP control and visual acuity improvement in pseudoexfoliation patients with coexisting cataract and glaucoma. Complication rate was low and did not affect the surgical outcome.