Refractive Astigmatism in Phaco-Canaloplasty vs Phaco-Non-Penetrating Deep Sclerectomy in 24-months Period, in a Randomized, Prospective Study.

Abstract

PurposeThis study aimed to assess refractive astigmatism, in Phaco-Canaloplasty (PC) vs Phaco-Non-Penetrating Deep sclerectomy (PDS) in a randomized, prospective study within 24 months.MethodsPatients were randomized pre-operatively, 37 underwent PC and 38 PDS. The following data was collected: BCVA, IOP, number of antiglaucoma medications, refraction with autokeratorefractometry. The assessment of astigmatism was simple arithmetic and vector analysis included double angle plots and cumulative refractive astigmatism graphs.ResultsPre-operative mean BCVA in PC was 0.40±0.43 and was comparable to BCVA in PDS 0.30±0.32logMAR (P=0.314). In the sixth month follow-up, mean BCVA showed no difference (P=0.708) and was 0.07±0.13 and 0.05±0.11, respectively. However, two years after the intervention mean BCVA was better in PC 0.05±0.12 than in PDS 0.12±0.23 and it was statistically significant (P=0.039). Mean astigmatism in PC at baseline was 1.13±0.73Dcyl and 1.35±0.91 for PDS(P=0.544). At six months it was 1.09±0.61 and 1.24±0.86 respectively,(P=0.595). At two years 1.17±0.51 for PC and 1.24±0.82(P=0.917). The direction of mean astigmatism was against the rule throughout observation for both groups. Centroids pre-operatively were 0.79D@172˚±1.10Dcyl in PC and 0.28D@10˚±1.63D in PDS. At six months 0.75D@166˚±1.01 and 0.26D@11˚±1.5, respectively. At 24-months 0.64D@164˚±1.11 and 0.47D@20˚±1.43. The mean baseline IOP in PC was 19.4±5.8mmHg and 19.7±5.4mmHg in PDS(P=0.639). From the six-month IOP was lower in PC, at 24-months it was 13.8±3.3mmHg in PC and 15.1±2.9mmHg in PDS(P=0.048). In both groups preoperatively patients used median(Me) of 3 antiglaucoma medications(P=0.197), at 24-months in PC mean 0.5±0.9 Me=0.0 and 1.1±1.2 Me=1.0 in PDS(P=0.058). ConclusionsBoth surgeries in mid-term observation are safe and effective. They do not generate vision-threatening astigmatism and don’t even change the preoperative direction of mean astigmatism. Refractive astigmatism is stable throughout the observation.