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Moderator
Nir Shoham-Hazon, MD
Panelists
Marc G. Bodman, MD, ABO; Kendrick M. Wang, MD
Viewing Papers
Expand a paper title to the right to view the paper abstract and authors. Use the video link to jump to that poster in the session.
Presenting Author
Cameron Oliver, MD, FRCSC
Co-Authors
Paul Harasymowycz (MD, FRCSC, MSc), Janelle LeBlanc (None)
Purpose
Immediately sequential bilateral cataract surgery (ISBCS) is commonplace. However, there are few published studies of immediately sequential glaucoma surgery. This study reports the safety outcomes of bilateral same day glaucoma surgery (BSDGS), specifically with minimally invasive glaucoma surgery (MIGS) procedures.
Methods
This was a retrospective longitudinal consecutive case series of 63 patients (126 eyes) undergoing bilateral same day glaucoma surgery with or without combined phacoemulsification. Inclusion criteria included glaucomatous damage in both eyes with need for intraocular pressure (IOP) or medication reduction, glaucoma surgeries limited to angle-based MIGS procedures, including iStent trabecular micro-bypass, Hydrus Microstent, or bent needle goniotomy, and minimum 1 month follow-up. Outcome measures included change in IOP, topical glaucoma medications, and best-corrected visual acuity. Complication rates were recorded and a comparison of complications between MIGS procedures was performed.
Results
IOP and topical glaucoma medication use were significantly reduced (p < 0.05) at various follow-up visits. In terms of safety, there were no cases of serious adverse ocular events. Bilateral complications occurred in 13 patients (20.6%). Transient IOP spikes and hyphema/microhyphema were most common. Meanwhile, bilateral simultaneous complications occurred in 10 patients (15.9%). Bilateral complications included transient IOP spikes, hyphema/microhyphema, cystoid macular edema, rebound uveitis, and retinal tears. Overall, 9 eyes (7.1%) required an anterior chamber (AC) paracentesis for acute IOP control. Two patients (3.2%) required bilateral AC paracenteses.
Conclusion
The known safety profiles of ISBCS and MIGS procedures suggest there is an opportunity to safely perform bilateral same day glaucoma surgery (BSDGS). This is the first study to provide evidence in support of the safety and feasibility of BSDGS when performed with MIGS procedures, specifically iStent, Hydrus, and bent needle goniotomy.
Presenting Author
Lisa K. Feulner, MD, PhD
Purpose
To evaluate IOP lowering, topical medication changes and safety in open angle glaucoma (OAG) or ocular hypertensive (OHT) eyes that underwent implantation of trabecular micro-bypass stents (TMB) in combination with implantation of an intracameral travoprost implant or cataract extraction.
Methods
This retrospective, single-center case series included all eyes receiving a TMB stent in combination with other MIGS, procedural pharmaceuticals or cataract surgery. The analysis presented here includes 13 eyes with mild to severe glaucoma receiving iStent infinite TMB stents with cataract surgery and 8 eyes with mild to moderate glaucoma receiving iStent infinite TMB stents with an iDose TR. IOPs and topical IOP-lowering medications (meds) were compared from a pre-operative baseline (BL) to month 3 (M3). No med washout was performed. Safety outcomes were assessed. Additional cases and data will be added prior to the presentation.
Results
In eyes receiving iStent infinite and cataract surgery with M3 data (n=19), BL mean+SD IOP was 14.4+3.2 mmHg on a 1.3+0.9 (mean+SD) meds. At M3 these eyes had significant reductions in mean+SD IOP to 12.1+2.8 mmHg (P=0.0038) and mean+SD meds 0.5+0.5 (P<0.0001). At M3, 10/19 eyes were on no topical meds compared to 2/19 eyes at BL. In eyes receiving iStent infinite, iDose TR and cataract surgery with M3 data (n=11), BL mean+SD IOP was 13.3+2.8 mmHg on a 2.1+1.3 (mean+SD) meds. At M3 these eyes had a reduction in mean+SD IOP to 12.2+2.3 mmHg on significantly fewer mean+SD meds 0.2+0.6 (P=0.0003). At M3, 10/11 eyes were on no topical meds compared to 1/11 eyes at BL. No safety findings noted.
Conclusion
iStent infinite and cataract surgery with or without iDose TR resulted in lower IOPs and topical med burden in patients with OHT or OAG. The data show combining iStent infinite with cataract surgery and/or iDose TR is an effective, customizable way to meet patients IOP needs or simplify and possibly eliminate the burden of topical glaucoma meds.
Presenting Author
Madhavi R Pillai, DNB, MBBS
Co-Authors
Devendra Maheshwari (MD), Nimrita Nagdev (MS, MBBS)
Purpose
To compare the surgical outcomes of 180 degree Tanito microhook Trabeculotomy combined with phacoemulsification (Phaco-TMH) and 5-0 prolene 360-degree gonioscopy-assisted transluminal trabeculotomy combined with phacoemulsification (Phaco-GATT) in mild-moderate Open-angle glaucoma Study Question -Limited Goniotomy Versus 360-degree GATT
Methods
Prospective,non randomised,comparative,interventional study of 110 patients who underwent Phaco-TMH(Group 1,N=55) and Phaco-GATT (Group 2,N=55).Consecutive sampling was done.Patients with open-angle Glaucoma (POAG,PXFG) and visually significant cataract were included.The primary outcome measures included changes in intraocular pressure (IOP), antiglaucoma medications (AGM), and best-corrected visual acuity (BCVA). Success was defined as a combination of at least 20%, 25%, or 30% reduction in IOP and an absolute IOP of less than 21, 18, or 15 mm Hg, respectively (Criteria 1, 2, and 3). Additionally, interventions and complications were compared between the groups.
Results
In Group 1,mean IOP reduced significantly from 24.38±6.29mmHg to 14.60±3.87 mmHg,in Group 2 from 25.45± 5.65mmHg to 12.80±3.12 mmHg at 12 months(p<0.001), with significant reduction in Group 2 (p=0.007).The percentage reduction of IOP was 37.5% and was 47.7%.AGM significantly reduced from 1.53±0.66 to 0.22±0.57 and from 1.64±0.73 to 0.09±0.29 in Groups 1 and 2,(p<0.001), with no significant difference between groups(p=0.137).Complete success by criteria 1, 2, and 3 in Group 1 was 74.6%, 69.1% and 52.7% ; and in Group 2 was 89.1%, 88.1% and 65.4% respectively.Hyphema was seen in one patient in Group 1,7 patients in Group 2, and two patients in Group 2 required AC wash.
Conclusion
180 degree Tanito Microhook Trabeculotomy with phacoemulsification, is nearly as efficacious and safe as 360 degree Gonioscopy-assisted transluminal trabeculotomy,with similar success rates and reduction in medications.Phaco-GATT achieved better intraocular pressure reduction at the end of 12 months.
Presenting Author
Anh-Viet T Nguyen, MD, BSc
Co-Authors
Haana McMurray (MD, BSc), Sorana Raiciulescu (MSc), Lauren Truax (MD), Won Kim (MD), Richard Lee (MD, PhD), Walker Toohey (DO)
Purpose
To report the long-term outcomes of combined Minimally Invasive Glaucoma Surgeries (MIGS) for the treatment of glaucoma
Methods
This is a nonrandomized retrospective study of 99 combined MIGS cases performed by a single glaucoma surgeon who specialized in combined MIGS procedures at the Walter Reed National Military Medical Center with up to 9 years of follow-up. MIGS performed included ab interno canaloplasty, trabecular micro-bypass procedures, and cyclophotocoagulation with combinations determined at the discretion of the surgeon who took into account each patient's therapy goals and ophthalmic history. Combinations were subcategorized into three groups based on their physiologic target of aqueous inflow and/or outflow.
Results
56% of eyes had severe glaucoma and 41% of eyes had a history of prior failed glaucoma filtration surgery. Combined MIGS achieved significant reductions in IOP from preoperative values out to 8 years from 23.3±1.0 mmHg (n=99) preoperatively to 14.5±1.2 mmHg at 3 years (n=40, p<0.001) and 12.5±2.7 mmHg at 8 years (n=6, p<0.001). Reductions in medication use was significant to 1 year. Treatment failure rates were 17%, 28%, and 36% at postoperative years 1, 3, and 9, respectively. There were 42 complications: iritis (13), MIGS occlusion by iris (8), IOP spike (9), cystoid macular edema (3), hyphema (4), RD (2), vitreous hemorrhage (1), Hydrus nickel allergy (1), and wound leak (1).
Conclusion
In a cohort of eyes heavily represented by severe glaucoma, combined MIGS achieved sustained significant reductions in IOP out to 8 years of follow up with modest reductions in medication burden. Combined MIGS was also found to have a favorable safety profile with most complications being transient and not visually significant.
Presenting Author
Paul J. Harasymowycz, MD, FRCSC, MSc
Co-Authors
Sebastien Gagne (MD, FRCSC), Iqbal Ike Ahmed (MD, FRCSC)
Purpose
To evaluate the safety, effectiveness, and economic impact implant-free office-based subconjunctival glaucoma procedure in first in human.
Methods
This is a multicenter, open-label studie, which enrolled adults ?40 with POAG uncontrolled on maximal tolerated medical therapy. The trial evaluated a minimally invasive bleb-forming implant-free scleral punch system (n?25). Primary outcome: mean IOP reduction at 6 months. Secondary outcomes: medication burden, safety, bleb morphology, PROs. Cost modeling used Canadian public payer assumptions with a 12-month time horizon.
Results
Preliminary results demonstrate clinically significant IOP reductions (?20% from baseline), decreased dependence on topical medications, and favorable bleb morphology with minimal complications. No serious device-related adverse events have been reported to date. Cost modeling projects up to 50% savings compared to OR-based procedures, driven by reduced surgical time, infrastructure needs, and postoperative care. This study remains ongoing, with 12-month follow-up and adaptive expansion planned.
Conclusion
Early clinical and economic data support the potential of this office-based procedure to safely lower IOP while improving access and reducing costs. This approache may offer a transformative alternative to conventional glaucoma surgery, especially in resource-limited settings.
Presenting Author
Sanjay K Mishra, MBBS, DNB
Purpose
To assess the efficacy and safety of excisional goniotomy with the Kahook Dual Blade (KDB), combined with phacoemulsification or stand alone, in angle‑closure glaucoma with or without coexisting cataract or pseudophakia in 200 Indian eyes
Methods
A prospective study in Indian eyes included patients undergoing KDB-assisted goniosynechialysis plus excisional goniotomy with or without phacoemulsification in angle closure. Primary endpoints were mean change in intraocular pressure (IOP) and medication burden at 12 months. Secondary endpoints included visual acuity improvement and incidence of surgical complications.
Results
Significant IOP reduction was noted, with mean IOP reduction from approximately 18–26.5 mmHg preoperatively to 10.9–14.1 mmHg at 12 months—a 23%–47% decrease (all P < 0.001) Medication use dropped markedly—from around 2.3 medications preoperative to 0.8–1.0 at 12 months (50%–90% reduction) About 79% of eyes achieved success (based on IOP criterion), outperforming earlier reports (e.g., 57.7%–71%) Visual acuity improved significantly: average logMAR BCVA improved from ~0.55 to ~0.16 at 12 months (P < 0.0001) Common complications included transient hyphema (10%–25%), IOP spikes (~14%–16%), and infrequent events such as choroidal detachment or iridodialysis
Conclusion
Significant IOP reduction was noted, with mean IOP reduction ranging from 23%–47% decrease 50%–90% reduction in medicines were seen over 12 months following the procedure Excisional Goniototomy is an effective procedure with or without Concurrent Cataract Surgery in angle closure glaucoma in Indian Eyes which matches the published data
Presenting Author
Ana IM Miguel, PhD
Purpose
We intended to perform a real-world population study with direct comparisons among different MIGS (micro-invasive glaucoma surgery) techniques.
Methods
We included patients submitted to MIGS surgery in our service (including iStent, iStent+goniotomy, Hydrus, ELIOS, GATT, goniotomy, and others), from January 2023 to April 2025. We excluded micro-invasive bleb surgery (MIBS:Preserflo, XEN, and MIMS), classical filtering surgery (trabeculectomy, deep sclerectomy), drainage devices (Ahmed, Baerveldt, EyeWatch). We also excluded patients with follow-up less than 6 months, and complex anterior segment surgeries. The main outcome was MIGS surgical success (defined as ≥20% IOP decrease without increasing medication, or decreasing at least one class without increasing IOP; without secondary glaucoma surgery nor serious complications).
Results
We included 436 eyes from 356 patients with surgeries from January 2023 to April 2025; most were submitted to iStent or iStent combined with goniotomy, followed by GATT (85 eyes), ELIOS, Hydrus, and others. There was no progression of the visual field for any patient during the follow-up. In all 436 patients, there were only 3 failures. The MIGS surgical success was very high, of >95% for all timepoints (nevertheless, there was a follow-up loss of> 20% at 2 years).
Conclusion
All MIGS techniques were effective and safe for the surgical treatment of glaucoma. GATT was more powerful in IOP decrease, at the cost of more hyphema. If the indications of MIGS, surgical technique, and follow-up are respected, the success rates can be very high, and MIGS can be effective in preventing glaucoma progression.
Presenting Author
Melissa N Porter, BSc
Co-Authors
Matthew Porter (MD), Emma Schmidt (BA), Megan Murchison (MBA, MS), Caroline Campbell (BSc), Zeid Nawas (MD), Joshua Van Swol (MD)
Purpose
To describe the complications associated with MIGS performed by residents, investigate trends for the purpose of evaluating safety and efficacy, and make recommendations to improve surgical training.
Methods
Three years of surgical data were retrospectively reviewed and evaluated for inclusion (n=209). Adult patients who underwent combined MIGS (iStent, Hydrus, canaloplasty, and goniotomy) with phacoemulsification performed by a resident in ophthalmology were included. Data collected included demographics, glaucoma severity, and type of MIGS procedure. Exclusion criteria included prior invasive glaucoma surgery (tube shunt, trabeculectomy, cyclophotocoagulation), other concurrent procedures, and lack of follow-up during the post-operative period. Statistics were performed using MedCalc Statistical Software and reported as proportions along with 95% CI for differences in categorical variables.
Results
The most common complications were hyphema with one case requiring washout, transient IOP spike, and persistent iritis. Rare complications included vitreous hemorrhage, cystoid macular edema, hypotony, iris trauma, iridodialysis, choroidal effusion, cyclodialysis cleft, and aborted procedures. Most conditions were self-limited without sequelae and only required temporary post-operative medication adjustments. Complication frequencies were found to be within the typical reported range for all procedure types.
Conclusion
MIGS offers a favorable safety profile to patients even when performed by residents. The common complications seen in the study are generally expected with MIGS and can be managed with close post-operative care. A small number of complications required escalation of care, highlighting the need for careful training and vigilance moving forward.
Presenting Author
Devendra Maheshwari, MD
Co-Authors
Nimrita Nagdev (MS, MBBS), Madhavi Pillai (DNB, MBBS)
Purpose
To assess the two year surgical outcomes of Ab interno Tanito microhook trabeculotomy combined with phacoemulsification versus standalone phacoemulsification in open angle glaucoma
Methods
Study design:Prospective,comparative, interventional , non randomised.Consecutive sampling was done Methods:93eyes(45 Phaco(P) grp ,48Tanito-phaco(T-P) grp)were included and followed for 2 wks,1,3,6,12 &24months.Outcome measures were Intraocular pressure(IOP), antiglaucoma medications (AGM ) ,Best corrected visual acuity (BCVA) ,surgical success,complications and interventions. Surgical success was defined as IOP ?21/?18/?15 with >20%, 25%,30% reduction from baseline respectively(Criteria 1,2 &3)
Results
Mean IOP decreased from 24.20±6.6 to 18.16± 4.0,18.60±3.7,18.29±2.8 mmHg in P group and from 24.31 ±6.5 to13.98±3.1,14.65 ±4.0,15.23±4.9 mmHg in T-P group at 6,12,24months respectively (p<0.001).AGM increased from1.36±0.57 to 1.53 ±0.65 and reduced from1.50± 0.68 to 0.40±0.73 in Pgrp(0%meds free) & T-Pgrp(72.1% meds free) respectively by 24 months(p<0.001). Complete & Qualified success was 66.7% ,64.6%,43.8% in T-P grp, 0%,0%,0% in Pgrp & 16.7%,8.3%,0% in T-Pgrp, 57.8%,40%,20% in Pgrp by criteria 1,2&3 (p<0.001).In T-P grp,4 patients had macrohyphema and one patient required anterior chamber wash for non resolving hyphema
Conclusion
Combining Tanito microhook(TMH) trabeculotomy with phacoemulsification offered better success when compared to phacoemulsification alone in open angle glaucoma at the end of two years.
Presenting Author
Maria C Pizarro Penaranda, MD
Co-Authors
Yulia Nam (MD), Natalie Hamilton (PhD), Valerie Wong (BEng), Elyse McGlumphy (MD), Thomas Johnson (MD, PhD)
Purpose
Intraocular pressure (IOP) reduction is the cornerstone of glaucoma management. Infrequent clinic assessments miss day-to-day fluctuations, increasingly recognized as a risk factor in disease progression. Patients with open-angle glaucoma used remote tonometry to assess IOP fluctuation before and after cataract surgery with Microstent implantation.
Methods
67 patients (95 eyes) were included. Patients were instructed to measure their IOP ?4 times a day for one week using the iCare HOME2 tonometer (iCare USA, Raleigh, NC) immediately before, immediately after, and at 6 months after undergoing surgery. In-clinic IOPs from the preoperative, postoperative and 6-month follow-up visits were extracted from the electronic medical record. IOP mean, maximum, minimum, range, standard deviation, coefficient of variation were calculated to assess IOP fluctuation. The frequency and extent of exceeding the patient-specific target IOP were calculated to assess IOP control.
Results
Linear mixed-effects modeling showed postoperative changes in classic and novel IOP metrics relative to the preoperative period. The mean and minimum IOP decreased at 1 week (p=0.0098; p<0.0001) and 6 months (p=0.0013; p=0.0022). The maximum IOP, range, standard deviation and coefficient of variation increased at 1 week (p=1.0; p=0.0024; p=0.0002; p<0.0001) but decreased at 6 months (p=0.011; p=0.20; p=0.23; p=1.0). Among the novel metrics, the Percentage of Measurements Above Threshold (PMAT) decreased at 1 week and 6 months (p=0.27; p=0.0037), while the Average IOP Excess (AIE) and Total IOP Excess (TIE) increased at 1 week (p=0.01; p=0.037) and decreased at 6 months (p=0.13; p=0.23).
Conclusion
Cataract surgery with Microstent implantation led to reductions in multiple IOP metrics in the short and medium term. Although some metrics showed early elevations, these were transient and overall pressure variability tended to improve by 6 months. Longer follow-up is warranted to evaluate the durability of these IOP changes.
Presenting Author
Madhavi R Pillai, DNB, MBBS
Co-Authors
Devendra Maheshwari (MD), Nimrita Nagdev (MS, MBBS)
Purpose
To assess the surgical outcomes of Gonioscopy assisted transluminal trabeculotomy in JOAG
Methods
Prospective, Non-Randomised, Interventional study.Patients diagnosed with JOAG underwent GATT and followed up on day one, 2 weeks, 1,3,6 months and 1 year.JOAG was diagnosed based on the following criteria: patients presenting between 10 and 40 years of age with IOP >21 mm Hg, wide-open angles in gonioscopy, and glaucomatous optic neuropathy, with corresponding visual field defects.The inclusion criteria were 1) patients on maximal medical therapy or those who could not tolerate it, 2) patients who showed progression, 3) target IOP not achieved with maximal medical therapy. Outcome measures were intraocular pressure,antiglaucoma medications,best corrected visual acuity and surgical success.
Results
30 eyes(26 patients) with 11(mild-moderate-Group 1)19-severe(Group 2) JOAG were included.Mean IOP reduced from 23.43±9.65 to 13.27±4.54(p=0.002) in group 1 and 23.26±9.80 to 14.10±8.32 at 1 year in group 2.Mean AGM reduced from 2.89±0.94 to 0.74±0.81 and 3±0.77 to 0.91±1.30(p<0.001) in group 1 and 2 .Mean IOP reduction was 36.3 % and 28.7% at 1 year in groups 1 and 2.Complete success ( IOP ?6 & ?21 mmHg &? 20% IOP reduction without AGM) was seen in 63.6%(30.0 - 84.5)&73.7%(47.9 - 88.1) (Grp 1&2).63.6% and 47.4% in each grp remained medication free. Microhyphema (<1mm) was the most common complication (6 patients), which resolved by the end of one week, with the need for AC wash in two cases.
Conclusion
GATT significantly reduced IOP and antiglaucoma medications with good surgical success and rare vision-threatening complications in Juvenile open angle glaucoma at the end of 1 year. It works equivocally in varying severity of glaucoma.
Presenting Author
Steven R. Sarkisian, Jr., MD
Co-Authors
Navaneet Borisuth (MD, PhD), Rupali Nangia (MS), Jill Ling (MSc), Yi-Jing Duh (PhD)
Purpose
ELIOS (Bausch + Lomb) is an ophthalmic excimer laser trabecular bypass minimally invasive glaucoma surgery (MIGS) system. This trial assessed the effectiveness and safety of the MIGS system to reduce intraocular pressure (IOP) in adults with primary open-angle glaucoma (POAG) undergoing cataract surgery. Study safety will be focus of this paper.
Methods
This prospective, non-randomized clinical trial (NCT04899063) enrolled patients aged ?45 years with mild-to-moderate POAG at 20 sites in the USA. Additional eligibility criteria included operable age-related cataract eligible for phacoemulsification with best-corrected visual acuity (BCVA) ? 20/40, medicated IOP of ?24 mmHg, and unmedicated diurnal IOP of 22-34 mmHg. Patients meeting all eligibility criteria underwent the ELIOS procedure after uncomplicated cataract surgery, with 24-months follow up. Key safety outcomes were the incidence of adverse events and mean percent endothelial cell loss from baseline, and distribution of post-operative BCVA. Results reflect findings at 12-month.
Results
318 patients underwent the procedure (mean±SD age 70.2±7.4 years). At 12-mo, 144 ocular AEs were reported in 107 patients (33.6%); 68% occurred within 1-mo, and 32% between Months 1–12. While early postoperative IOP elevations ≥10 mmHg were predominantly transient, the incidence of sustained or later-onset IOP elevation (≥1 month) was low at 1.5%. Most ocular AEs were mild or moderate and occurred in the early postop without clinically meaningful sequelae. ECD loss demonstrated early postoperative reduction with stabilization by Month 3. All patients achieved BCVA of 20/40 or better at 12-mo (n=307). No unanticipated device effects or procedure related intraoperative AEs occurred.
Conclusion
Excimer laser trabeculostomy MIGS with ELIOS was associated with a low rate of serious AEs, and over 66% of patients not experiencing any AEs at 12 months. Reported AEs are in-line with those described in the literature for standalone cataract surgery. No intraoperative complications or unanticipated adverse device effects were reported.
Presenting Author
Michael S. Berlin, MD, MSc
Co-Authors
Jonathan Shakibkhou (MD)
Purpose
We are investigating AI-enhanced, goniolens-free guidance using 2D endoscopy and 3D OCT to assess whether it maintains or improves canal-based MIGS efficacy, reduces technique-dependent variability, and enables a broader range of ophthalmic surgeons to safely perform concurrent MIGS.
Methods
1. 2D Guided ELT: Real-time endoscopic imaging augmented with artificial intelligence overlays that identify and label critical landmarks—trabecular meshwork (TM), Schlemm's canal (SC), and collector channels—superimposed onto the surgical microscope field. This creates a simulated gonioscopic view without the need for a goniolens. 2. 3D Guided ELT: Integration of fiber-optic and microscope-based OCT which generate depth-resolved enabling visualization of real-time surgical instrumentation, Schlemm's canal targets and the distal outflow pathways with picture-in-picture AR renderings.
Results
Visualization & Accuracy: 2D guidance will replicate gonioscopic orientation, reducing misplacement of stents and ELT channels. 3D OCT guidance will enhance targeting of Schlemm's canal and collector channels, improving accuracy of placement and durability of outflow. Consistency & Adoption: Removal of the surgical goniolens requirement will shorten the learning curve for cataract surgeons and expand MIGS adoption globally. Patient Impact: Improved access to MIGS is expected to lower long-term IOP, reduce medication burden, and delay the need for incisional glaucoma surgery, translating to better vision preservation and quality of life.
Conclusion
The global glaucoma epidemic demands innovations that expand access to safe, effective surgery. Enabling cataract surgeons to perform canal-based MIGS with goniolens-free guidance can overcome training barriers, standardize outcomes, and support sustainable worldwide glaucoma care.
Presenting Author
Madhavi R Pillai, DNB, MBBS
Co-Authors
Devendra Maheshwari (MD), Nimrita Nagdev (MS, MBBS)
Purpose
To compare the two year outcomes of Gonioscopy assisted transluminal trabeculotomy combined with phacoemulsification in primary open angle glaucoma versus primary angle closure glaucoma
Methods
Study design: Prospective comparative ,non randomised. Methods:121 consecutive eyes(61 POAG and 60 PACG)underwent 5-0 prolene suture GATT-Phaco and followed for 2 wks,1,3,6,12 and 24 months.Outcome measures were Intraocular pressure( IOP),antiglaucoma medications (AGM),Best corrected visual acuity (BCVA), surgical success,complications and interventions. Surgical success was defined as IOP ?21/?18/?15 with>20%,25%,30% reduction from baseline(Criteria1,2 &3).
Results
Mean IOP decreased from 21.15±3.7 to13.20±3.5,13.20±3.2,13.96±3.4 mmHg in POAG(33%IOP reduction) and from 21.88±6.4 to12.72±3.0.13.37±3.6,13.27±3.9 mmHg in PACG(33.8% IOP reduction) at 6,12,24months respectively (p=0.511).AGM reduced from 1.64± 0.84 to 0.38±0.59 in POAG(67.9%meds free) and from 1.95±0.95 to 0.53±0.79 in PACG(61.8% meds free)at24 months (p=0.21).Complete success was 65.6%,62.3%49.2% in POAG and 56.7%,55%43.3% in PACG by Criteria1,2&3.Qualified success was 19.7% ,14.8%,11.5% in POAG and 26.7%,21.7%,15% in PACG.14 eyes had macrohyphema,10 eyes had IOP spikes.1 patient with PACG had one clock hour iridodialysis. 6 eyes underwent anterior chamber wash for non resolving hyphema
Conclusion
GATT combined with phacoemulsification is efficacious with similar surgical outcomes in both POAG and PACG, with a favourable safety profile. The results of this study reinforce that angle-closure does not preclude the use of GATT, expanding the role of MIGS in PACG management as well.
Presenting Author
Arkadiy Yadgarov, MD
Co-Authors
John Stephens (MD)
Purpose
To evaluate the IOP-lowering and post-surgical safety outcomes in patients with open-angle glaucoma using a micro-interventional approach with intraluminal, visco-free canaloplasty followed by circumferential goniotomy.
Methods
Patients were analyzed from CIRCLE—a prospective, multicenter, observational study evaluating the surgical outcomes of a intraluminal, visco-free canal dilation followed by 180-degree excisional goniotomy using a super-elastic, nitinol filament technology, The nitinol filament has a self-guiding bulbous tip for both mechanical canal dilation without the need for the viscoelastic, as well as flexible column strength for guided forward disruption of the trabecular meshwork. Intraocular pressure (IOP) lowering, medication usage, and safety events were tracked for 12 months (12M).
Results
Preliminary data on 23 eyes from the CIRCLE study were evaluable at 12M in the analysis cohort. The baseline mean ± SD IOP was 17.4 ± 3.9 mmHg and the mean ± SD medication use was 1.2 ± 0.9. At 12M, the IOP reduced to 14.4 ± 3.9 mmHg on a corresponding number of medications of 0.7 ± 1.2. There was a statistically significant lowering of IOP (p<0.01) and concomitant medication mean reduction of 40%. There were no serious adverse events and the safety profile was consistent with a MIGS-like canal intervention.
Conclusion
Intraluminal visco-free canaloplasty with 180-degree excisional goniotomy resulted in substantial IOP-lowering effect and medication reduction at 12M. Further studies are needed to continue assessing the potential of this innovative approach.
