Outcomes of Phaco-viscocanalostomy in Primary Open Angle Glaucoma versus Pseudoexfoliation Glaucoma
Purpose: Viscocanalostomy represents an alternative to standard penetrating glaucoma surgery. The aim of this study is to compare the outcomes of combined phacoemulsification and viscocanalostomy in eyes with primary open-angle glaucoma (POAG) versus eyes with pseudoexfoliation glaucoma (PEXG).
Methods: In this prospective non-randomized comparative study, eyes with cataract and POAG or PEXG were enrolled. Pre- and postoperative data including best corrected visual acuity (BCVA), intraocular pressure (IOP), and the number of antiglaucoma medications administered were recorded at each visit. All patients underwent phacoviscocanalostomy. Complete success was defined as the IOP of 21 mmHg or less without the administration of medication while a qualified success reported the same IOP parameters either with or without the administration of medication.
Results: Fifty-four eyes with POAG and fifty-four with PEXG underwent phacoviscocanalostomy. The mean follow-up time was 23.36 ± 8.8 months (range, 6–40 months). The mean postoperative IOP reduced significantly in both groups, although the mean IOP reduction was significantly greater in PEXG eyes (14.7 ± 8.9 vs 10.1 ± 7.7 mmHg) (P = 0.05). At the final follow-up visit, the mean postoperative IOP was 14.1 ± 2.1 and 16.6 ± 3.5 mmHg in the PEXG and POAG eyes, respectively (P = 0.001). A complete success rate of 88.9% and 75.9% was achieved in PEXG and POAG eyes, respectively (P = 0.07). The qualified success rate was 100% in the PEXG and 85.2% in POAG groups (P = 0.03).
Conclusion: Phacoviscocanalostomy achieved significant IOP reduction and visual improvement in both POAG and PEXG patients. Our results indicated that in terms of IOP reduction, this procedure was more effective in treating PEXG.
Primary Open-angle Glaucoma, Intraocular Pressure, Phacoviscocanalostomy, Pseudoexfoliation
1. Naumann GO, Schlötzer-Schrehardt U, Küchle M. Pseudoexfoliation syndrome for the comprehensive ophthalmologist: intraocular and systemic manifestations. Ophthalmology 1998;105:951–968.
2. Rao KN, Ritch R, Dorairaj SK, Kaur I, Liebmann JM, Thomas R, et al. Exfoliation syndrome and exfoliation glaucomaassociated LOXL1 variations are not involved in pigment dispersion syndrome and pigmentary glaucoma. Mol Vis 2008;14:1254.
3. Leske MC, Heijl A, Hussein M, Bengtsson B, Hyman L, Komaroff E. Factors for glaucoma progression and the effect of treatment: the early manifest glaucoma trial. Arch Ophthalmol 2003;121:48–56.
4. Caretti L, Buratto L. Non-penetrating glaucoma surgery (NPGS): viscocanalostomy, deep sclerectomy and canaloplasty. Glaucoma Surgery: Springer; 2018. p. 23–40.
5. Chiselita D. Non-penetrating deep sclerectomy versus trabeculectomy in primary open-angle glaucoma surgery. Eye 2001;15:197–201.
6. Sayed MS, Lee RK. Recent advances in the surgical management of glaucoma in exfoliation syndrome. J Glaucoma 2018;27:S95.
7. Stegmann R, Pienaar A, Miller D. Viscocanalostomy for open-angle glaucoma in black African patients. J Cataract Refract Surg 1999;25:316–322.
8. O’Brart D, Shiew M, Edmunds B. A randomised, prospective study comparing trabeculectomy with viscocanalostomy with adjunctive antimetabolite usage for the management of open angle glaucoma uncontrolled by medical therapy. Br J Ophthalmol 2004;88:1012–1017.
9. Gabai A, Cimarosti R, Battistella C, Isola M, Lanzetta P. Efficacy and safety of trabeculectomy versus nonpenetrating surgeries in open-angle glaucoma: a meta-analysis. J Glaucoma 2019;28:823–833.
10. Ho DK-h, Garrick A, Aazem S, Mathews D. Effect of primary phacoviscocanalostomy/viscocanalostomy on intraocular pressure of normal tension glaucoma patients: 3-year results. BMC Ophthalmol 2017;17:1–6.
11. Mandić Z, Sarić D, Bojić L. Visco and phacoviscocanalostomy in managing glaucoma patients. Coll Antropol 2002;26:165–169.
12. Shoji T, Tanito M, Takahashi H, Park M, Hayashi K, Sakurai Y, et al. Phacoviscocanalostomy versus cataract surgery only in patients with coexisting normal-tension glaucoma: midterm outcomes. J Cataract Refract Surg 2007;33:1209–1216.
13. Hassan K, Awadalla M. Results of combined phacoemulsification and viscocanalostomy in patients with cataract and pseudoexfoliative glaucoma. Eur J Ophthalmol 2008;18:212–219.
14. Park M, Hayashi K, Takahashi H, Tanito M, Chihara E. Phaco-viscocanalostomy versus phaco-trabeculotomy: a middle-term study. J Glaucoma 2006;15:456–461.
15. Tanito M, Park M, Nishikawa M, Ohira A, Chihara E. Comparison of surgical outcomes of combined viscocanalostomy and cataract surgery with combined trabeculotomy and cataract surgery. Am J Ophthalmol 2002;134:513–520.
16. Mendrinos E, Mermoud A, Shaarawy T. Nonpenetrating glaucoma surgery. Surv Ophthalmol 2008;53:592–630.
17. Ritch R, Schlötzer-Schrehardt U. Exfoliation syndrome. Surv Ophthalmol 2001;45:265–315.
18. Conway RM, Schlötzer−Schrehardt U, Küchle M, Naumann GO. Pseudoexfoliation syndrome: pathological manifestations of relevance to intraocular surgery. Clin Experiment Ophthalmol 2004;32:199–210.
19. Cursiefen C, Hammer T, Küchle M, Naumann GO, Schlötzer−Schrehardt U. Pseudoexfoliation syndrome in eyes with ischemic central retinal vein occlusion: a histopathologic and electron microscopic study. Acta Ophthalmol Scand 2001;79:476–478.
20. Yalvac IS, Sahin M, Eksioglu U, Midillioglu IK, Aslan BS, Duman S. Primary viscocanalostomy versus trabeculectomy for primary open-angle glaucoma: three-year prospective randomized clinical trial. J Cataract Refract Surg 2004;30:2050–2057.
21. Want A, Ho DK-H, Karri B, Mathews D. The efficacy of viscocanalostomies and combined phacoemulsification with viscocanalostomies in the treatment of patients with glaucoma: a non-randomised observational study. BMC Ophthalmol 2018;18:1–8.
22. Gunenc U, Ozturk T, Arikan G, Kocak N. Long-term results of viscocanalostomy and phacoviscocanalostomy: a twelve-year follow-up study. Int J Ophthalmol 2015;8:1162.
23. Awadalla MA, Hassan KM. Phacoviscocanalostomy in pseudoexfoliation glaucoma versus primary open-angle glaucoma. Can J Ophthalmol 2011;46:77–82.
24. Moghimi S, Hamzeh N, Mohammadi M, Khatibi N, Bowd C, Weinreb RN. Combined glaucoma and cataract surgery: comparison of viscocanalostomy, endocyclophotocoagulation, and ab interno trabeculectomy. J Cataract Refract Surg 2018;44:557–565.
25. Tsagkataki M, Bampouras T, Choudhary A. Outcomes of viscocanalostomy and phaco-viscocanalostomy in patients with advanced glaucoma. Graefes Arch Clin Exp Ophthalmol 2018;256:1481–1487.
26. Stangos AN, Mavropoulos A, Sunaric-Megevand G. Phacoviscocanalostomy for open-angle glaucoma with concomitant age-related cataract. Clin Ophthalmol 2007;1:497.
27. Wishart PK, Wishart MS, Choudhary A, Grierson I. Long−term results of viscocanalostomy in pseudoexfoliative and primary open angle glaucoma. Clin Experiment Ophthalmol 2008;36:148–155.
28. Friedman DS, Jampel HD, Lubomski LH, Kempen JH, Quigley H, Congdon N, et al. Surgical strategies for coexisting glaucoma and cataract: an evidence-based update. Ophthalmology 2002;109:1902–1913.
29. Masis M, Mineault PJ, Phan E, Lin SC. The role of phacoemulsification in glaucoma therapy: a systematic review and meta-analysis. Survey of ophthalmology 2018;63:700–710.
30. Park M, Tanito M, Nishikawa M, Chihara E. Ultrasound biomicroscopy of intrascleral lake after viscocanalostomy and cataract surgery. J Glaucoma 2004;13:472–478.