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Abstract #99300 Published in IGR 22-4
Intraocular Pressure and Medication Burden with Cataract Surgery Alone, or Cataract Surgery Combined with Trabecular Bypass or Goniotomy
McNiel CL; Sanchez FG; Sanchez FG; Rees JP; Gardiner SK; Young JW; Kinast RM; Young A; Jones EP; Mansberger SLJournal of Glaucoma 2022; 31: 423-429
PRECIS: When compared to cataract surgery in glaucoma patients, trabecular micro-bypass and goniotomy resulted in a large decrease in the incidence of IOP spikes, a modest effect on IOP, and a minimal effect on medication burden. PURPOSE: To compare changes in intraocular pressure (IOP) and ocular hypotensive medications in 3 surgical cohorts: cataract surgery, cataract surgery with trabecular micro-bypass (cataract/trabecular), and cataract surgery with goniotomy (cataract/goniotomy). PARTICIPANTS AND METHODS: We included 138 eyes diagnosed with open angle glaucoma: (1) 84 eyes with cataract surgery alone, (2) 25 eyes with cataract/trabecular surgery, and (3) 29 eyes with cataract/goniotomy surgery. We compared the groups for postoperative IOP and the number of ocular hypotensive medications. We adjusted for preoperative IOP, and preoperative and postoperative number of ocular hypotensive medications. We defined an IOP spike as IOP ≥21▒mmHg and 10▒mmHg higher than preoperative on postoperative day 1. RESULTS: All 3 surgeries showed a decrease in IOP (P≤0.004) and medication burden (P≤0.001) at 3 and 6 months postoperatively when compared to their own preoperative baselines. When compared to cataract surgery alone, cataract/trabecular and cataract/goniotomy had similar IOP lowering at 1 month postoperatively, and variable results at 3 months and 6 months. The change in ocular hypotensive medications was not statistically different between the surgical groups at any postoperative visit. Cataract/trabecular and cataract/goniotomy decreased IOP on postoperative day 1, and had relative risk reduction of approximately 70% for IOP spikes (P≤0.001 for both). CONCLUSION: Trabecular micro-bypass and goniotomy when added to cataract surgery resulted in a large decrease in IOP spikes, a modest effect on IOP, and a minimal effect on medication burden when compared to cataract surgery alone in glaucoma patients.
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