Outcomes of Partial Versus Complete Goniotomy With or Without Phacoemulsification for Primary Open Angle Glaucoma: A Multicenter Study

Abstract

Précis: Goniotomy (GT) 120 degrees with or without phacoemulsification was sufficient to lower the intraocular pressure (IOP) and reduce hyphema for primary open angle glaucoma. Purpose: To compare the surgical outcomes and safety profiles of 120 degrees and 360 degrees GT with or without phacoemulsification cataract extraction and intraocular lens implantation (PEI) for primary open angle glaucoma. Patients and Methods: This multicenter retrospective study consisted of 139 eyes and was divided into 4 groups: (1) 120 degrees GT, (2) 360 degrees GT, (3) PEI + 120 degrees GT, and (4) PEI + 360 degrees GT. IOP, number of topical hypotensive medications, and complications were recorded and evaluated at baseline and at the final visit. The complete and qualified success rate and their potential associated factors were also investigated. The effectiveness and safety profile of the surgery were compared between different subgroups. Results: After a mean follow-up of 8.6 months, the IOP reduction was 13.2 ± 8.3 (38.8 ± 28.8%), 12.4 ± 8.3 (41.6 ± 18.2%), 12.8 ± 9.9 (39.4 ± 34.5%), and 13.8 ± 7.2 (46.0±17.1%) mm Hg in 120 degrees, 360 degrees, PEI + 120 degrees GT group, and PEI + 360 degrees GT, respectively. No significant difference was found in IOP, a decline of IOP from baseline, topical hypotensive medication, and complete or qualified success between either standalone 120 degrees versus 360 degrees GT, or PEI + 120 degrees versus PEI + 360 degrees GT (all Ps > 0.05). The PEI + 120 degrees GT group had a lower final IOP than the 120 degrees GT group (P = 0.0002) whereas there was no difference between PEI + 360 degrees GT and 360 degrees GT group (P = 0.893). Both 360 degrees GT and PEI + 360 degrees GT group had a significantly higher incidence of hyphema than the 120 degrees GT and PEI + 120 degrees GT groups (all Ps < 0.0001). Conclusions: GT of 120 or 360 degrees lowered IOP equally with or without cataract surgery, and hyphema was most commonly noted after complete GT. Partial GT alone or in combination with cataract surgery was an effective and safe approach to manage patients with open angle glaucoma.

Comparison of Phaco-Tanito Microhook Trabeculotomy between Propensity-Score-Matched 120-Degree and 240-Degree Incision Groups

“…Postoperative layered hyphema was more frequently reported with a 360-degree incision compared to a 180-degree incision in GATT procedures [9]. Similarly, the incidence of hyphema was more common following goniotomy with a 360-degree incision than with a 120-degree incision [12,13]. In our previous research, we reported higher hyphema scores in eyes undergoing TMH than in those receiving first-and secondgeneration iStent implants during the early postoperative period [19,29].…”

“…Studies on cadaver eyes suggested that the extent of trabeculotomy incision influences IOP reduction [4]. While some studies reported varying IOP reduction efficacy based on the width of the surgical extent [5][6][7], others found no such differences [8][9][10][11][12][13]. Assessments of the correlation between surgical extent and IOP reduction efficacy often involved comparing different surgical procedures or groups with varying preoperative IOP or patient backgrounds [5][6][7]10,13].…”

Comparison of Superior versus Inferior Canaloplasty and Trabeculotomy Using the OMNI Surgical System

“… 6 In another study, Song et al also found no significant difference in IOP reduction when performing goniotomy on 120 vs 360 degrees with or without phacoemulsification (Tanito Microhook or KDB for the 120 degree goniotomy and GATT for 360 degrees). 7 Similarly, Hughes et al found no difference in IOP reduction at 18 months in eyes treated with 180 or 360 degrees of canaloplasty using the Visco360 or OMNI device. 8 While further research is needed to delineate these outcomes, the potentially varying regions being targeted in these studies may be at least partially responsible for these results.…”

“… 4 , 5 Lastly, treating more than 180 degrees may increase the risk of post-operative complications, such as hyphema and inflammation, which could lead to less favorable outcomes or more complicated post-operative recovery periods. 7 , 13 …”

“…[1][2][3] The arc length and location of trabeculotomy procedures have long been speculated to impact outcomes. Recent studies suggest that variable arc lengths may not have a major impact on outcomes, [4][5][6][7][8] however the location of the treatment arc has not been studied until now. The OMNI Surgical System (OMNI) is a MIGS device developed to perform ab-interno microcatheterization and transluminal viscodilation of Schlemm's canal (canaloplasty) followed by ab-interno transluminal trabeculotomy.…”