Combined MIGS: Comparing Additive Effects of Phacoemulsification, Endocyclophotocoagulation, and Kahook Dual Blade

Abstract

Purpose Combining two or more MIGS (cMIGS) promises to be more efficacious than single MIGS (sMIGS). This study compared the efficacy of PEcK, which combines Phacoemulsification (Phaco), Endocyclophotocoagulation (ECP), and Kahook dual blade (KDB), relative to both of its constituent sMIGS, Phaco/ECP (Endo Optiks, NJ) and Phaco/KDB (New World Medical, CA) for the first time. Patients and methods Data was collected retrospectively from 1833 visits of 271 patients who underwent PEcK, Phaco/ECP, or Phaco/KDB from 2016–2021 at Massachusetts Eye and Ear. Primary outcomes included Generalized Estimating Equations (GEE) of intraocular pressure (IOP) and medication burden, as well as survival models. Results Mean preoperative IOP was 17.6 ± 5.0 (SD) mmHg on 3.0 ± 1.4 medications in the PEcK group (n = 128), 17.9 ± 5.1 mmHg on 2.2 ± 1.5 medications in the Phaco/ECP group (n = 78), and 16.1 ± 4.3 mmHg on 0.4 ± 1.0 medications in the Phaco/KDB group (n = 65). For more than 36 months, all procedures resulted in significant patterns of IOP and medication reduction (all p < 0.001), before and after statistical adjustment. The reduction pattern in IOP was significantly different when comparing all groups over time and favored PEcK (p = 0.04), but the reduction pattern in medications was not significantly different (p = 0.11). Procedures did not differ in procedural time (p = 0.18) or in survival to maintain ≥20% IOP reduction (p = 0.43) without additional medication or procedure. There was a trend toward significant difference in maintaining IOP ≤ goal IOP that favored PEcK over Phaco/ECP after adjustment (p = 0.09). Conclusion PEcK may confer greater IOP reduction without added procedural time compared to Phaco/ECP and Phaco/KDB in predominantly mild or moderate glaucoma. Further research on cMIGS may benefit from adopting this comparative analysis to constituent MIGS.

Endocyclophotocoagulation Combined with Phacoemulsification in Glaucoma Treatment: Five-Year Results

“…The mean IOP at the 60-month followup was reduced by 32.7%, with a qualified success rate of 40%. These results exceed those of the only available 5-year study conducted by Oberfeld et al [20]. We attribute this difference to the extent of the ciliary process treatment, which in their study covered 90-360 degrees, whereas in our study it spanned 270-360 degrees.…”

“…The qualified success rate was observed to be reasonable. The incidence of adverse events aligns with the findings reported in prior publications [15,[18][19][20][21].…”

“…No other significant intraoperative or postoperative complications were observed. The incidence of major complications in our study is comparable to the results published to date [15,[18][19][20][21].…”

“…Other studies related to phaco-ECP have shorter follow-up durations. Oberfeld et al [20] reported a 12% success rate at 60 months after phaco-ECP, with an 18% reduction in intraocular pressure (IOP) among the 9 patients who remained in the study out of the initial 78 enrolled. After 36 months, the same authors reported 27 patients still in the study, with a 25% reduction in IOP and a 34% success rate.…”

“…This decrease is attributed to increased inflammation and bleb fibrosis [36,37]. In the aforementioned earlier study by Oberfeld et al [20], notable for its extensive follow-up duration, a comparative analysis was conducted between phaco-ECP, phaco-KDB, and PEcK (combined phacoemulsification, ECP, and KDB). This study revealed similar results between the phaco-ECP and phaco-KDB groups but a greater reduction in the PEcK group [20].…”