Background: Cataract and glaucoma are both common comorbidities among older patients. Combining glaucoma\r\nsurgery with minimal invasive phacoemulsification (phaco) is a considerable option to treat both conditions at the\r\nsame time, although the combination with filtration surgery can produce a strong inflammatory response.\r\nCombined non-penetrating procedures like canaloplasty have shown to reduce intraocular pressure (IOP)\r\ncomparable to trabeculectomy without the risk of serious bleb-related complications. The purpose of this\r\nretrospective study was to compare the outcomes of phacotrabeculectomy and phacocanaloplasty.\r\nMethods: Thirty-nine eyes with concomitant cataract and glaucoma who underwent phacotrabeculectomy (n = 20;\r\n51.3%) or phacocanaloplasty (n = 19; 48.7%) were included into this trial on reduction of IOP, use of medication,\r\nsuccess rate, incidence of complications and postsurgical interventions. Complete success was defined as IOP\r\nreduction by 30% or more and to 21 mmHg or less (definition 1a) or IOP to less than 18 mmHg (definition 2a)\r\nwithout glaucoma medication.\r\nResults: Over a 12-month follow-up, baseline IOP significantly decreased from 30.0 �± 5.3 mmHg with a mean of\r\n2.5 �± 1.2 glaucoma medications to 11.7 �± 3.5 mmHg with a mean of 0.2 �± 0.4 medications in eyes with\r\nphacotrabeculectomy (P < .0001). Eyes with phacocanaloplasty had a preoperative IOP of 28.3 �± 4.1 mmHg and\r\nwere on 2.8 �± 1.1 IOP-lowering drugs. At 12 months, IOP significantly decreased to 12.6 �± 2.1 mmHg and less\r\nglaucoma medications were necessary (mean 1.0 �± 1.5 topical medications; P < .05). 15 patients (78.9%) with\r\nphacotrabeculectomy and 9 patients (60.0%) in the phacocanaloplasty group showed complete success according\r\nto definition 1 and 2 after 1 year (P = .276). Postsurgical complications were seen in 7 patients (36.8%) of the\r\nphacocanaloplasty group which included intraoperative macroperforation of the trabeculo-Descemet membrane\r\n(5.3%), hyphema (21.1%) and bleb formation (10.5%). Although more complications were observed in the\r\nphacotrabeculectomy group, no statistically significant difference was found.\r\nConclusions: Phacocanaloplasty offers a new alternative to phacotrabeculectomy for treatment of concomitant\r\nglaucoma and cataract, although phacotrabeculectomy yielded in better results in terms of IOP maintained\r\nwithout glaucoma medications.
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