Efficacy, Safety, and Survival Rates of IOP-lowering Effect of Phacoemulsification Alone or Combined With Canaloplasty in Glaucoma Patients

Purpose: To evaluate efficacy and survival rates of intraocular pressure (IOP)-lowering effect obtained with phacoemulsification (phaco) alone or in combination with canaloplasty (PCP) in patients with open-angle glaucoma (OAG). Methods: Retrospective chart review of consecutive cases at the Department of Ophthalmology, Indiana University. Visual acuity (VA), IOP, number of medications (Meds), failures, and survival rates of IOP-lowering effect were analyzed. Inclusion criteria were: patients older than 18 years with OAG and cataract. Exclusion criteria were: no light perception vision, prior glaucoma surgery, chronic uveitis, angle-closure glaucoma, and advanced-stage or end-stage OAG. Failure criteria were: IOP > 21mm Hg or < 20% reduction, IOP < 6mm Hg, further glaucoma surgeries, and loss of light perception vision. Results: Thirty-seven patients underwent phaco and 32 patients had PCP. Follow-up was 21.8 +/- 10.1 versus 18.8 +/- 9.6 months for phaco and PCP, respectively (P = 0.21). Age (y) (74.7 +/- 9.8 vs. 76.1 +/- 8.3, P = 0.54), sex (P = 81), and laser status (P = 0.75) were similar between the groups. Preoperatively, mean +/- SD log(MAR) VA (0.5 +/- 0.7 vs. 0.5 +/- 0.5, P = 0.77), IOP (16.2 +/- 4.6 vs. 18.2 +/- 5.1, P = 0.13), and Meds (1.4 +/- 1.1 vs. 1.3 +/- 0.7, P = 0.75) were similar for phaco and PCP, respectively. At 24-month phaco (n = 17) and PCP (n = 11), respectively, mean +/- SD were: log(MAR) VA 0.2 +/- 0.2 versus 0.4 +/- 0.7, P = 0.29; IOP 14.1 +/- 4.0 versus 12.9 +/- 3.8, P = 0.43; and Meds 1.5 +/- 1.2 versus 0.3 +/- 0.5, P = 0.005. Rates of successful IOP lowering without medications for phaco versus PCP at 12 months were 34% versus 75%, respectively (P = 0.003). Conclusions: A combination of canaloplasty with phaco results in a decreased number of glaucoma medications and increased survival rate of IOP-lowering effect compared with phaco alone.