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Combined ab externo Schlemm’s canal surgery and phacoemulsification with intraocular lens implantation in management of open angle glaucoma in cataract patients: long-term result

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First Author: G.Dushina RUSSIA

Co Author(s):    K. Vinod   M. Frolov   A. Bezzabotnov   A. Sradka   K. Kazakova        

Abstract Details

Purpose:

To evaluate the effectiveness of segmental Schlemm’s canal (SC) distension using Kumar’s Schlemm’s canal expander (SCE) in decreasing intraocular pressure (IOP) in cataract patients suffering from open angle glaucoma (OAG).

Setting:

People’s Friendship University of Russia (RUDN University), Moscow, Russian Federation. Moscow City Clinical Hospital after V.M. Buyanov, Ophthalmic unit

Methods:

Between October, 2012 and March, 2020 in a prospective interventional case series study. SCE device, made from 0.04mm thick medical grade stainless steel wire, having inner lumen diameter of 0,12mm and outer – 0,2mm, 4-5 mm long was implanted into SC ab externo after completion of cataract surgery of 59 patients suffering from OAG Outcome measures were IOP change, number of glaucoma medications pre- and postoperatively and complications. Success rates were evaluated using World Glaucoma Association guidelines. A paired t-test was used for analysis. Results were significant when p less than 0,05.

Results:

Mean preoperative IOP was 28+/–4.7mmHg and mean number of medications - 2,4+/–0,8. At 4 years mean IOP reduced by 27%+/–15.5% and was 20,4+/–4,9 (n=59; p=.0000006) use of medications reduced to 1+/–1,2 (p=.0000001). Сomplete success was achieved in 24% (14/59) cases and partial – in 49% (29/59) respectively. Intraoperatively, microperforation occurred in 5 cases (8,5%). Postoperatively, 6 cases (10%) required YAG laser trabeculopuncture to control IOP. In these cases one end of SCE was lying in anterior chamber angle without contact with intraocular structures. Postoperatively, specific complications related to SCE were rare. In one case the body of SCE ruptured TM because of extra pressure put on eye ball while inserting goniolens. Both ends of the expander were embedded in SC. Patient’s IOP was under control with one medication.

Conclusions:

Results of combined surgery – phacoemulsification with intraocular lens implantation and SCE implantation in surgical management of OAG in cataract patients show significant reduction in IOP from the baseline and in hypotensive medication(s) use in long term period.

Financial Disclosure:

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