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Efficacy, Safety, and Survival Rates of IOP-lowering Effect of Phacoemulsification Alone or Combined With Canaloplasty in Glaucoma Patients

Arthur, Stella N. MD, MSPH*,†; Cantor, Louis B. MD*; WuDunn, Darrell MD, PhD*; Pattar, Guruprasad R. MD*; Catoira-Boyle, Yara MD*; Morgan, Linda S. CCRC, COA*; Hoop, Joni S. CCRC, COA*

doi: 10.1097/IJG.0b013e3182741ca9
Original Studies

Purpose: To evaluate efficacy and survival rates of intraocular pressure (IOP)-lowering effect obtained with phacoemulsification (phaco) alone or in combination with canaloplasty (PCP) in patients with open-angle glaucoma (OAG).

Methods: Retrospective chart review of consecutive cases at the Department of Ophthalmology, Indiana University. Visual acuity (VA), IOP, number of medications (Meds), failures, and survival rates of IOP-lowering effect were analyzed. Inclusion criteria were: patients older than 18 years with OAG and cataract. Exclusion criteria were: no light perception vision, prior glaucoma surgery, chronic uveitis, angle-closure glaucoma, and advanced-stage or end-stage OAG. Failure criteria were: IOP>21 mm Hg or <20% reduction, IOP<6 mm Hg, further glaucoma surgeries, and loss of light perception vision.

Results: Thirty-seven patients underwent phaco and 32 patients had PCP. Follow-up was 21.8±10.1 versus 18.8±9.6 months for phaco and PCP, respectively (P=0.21). Age (y) (74.7±9.8 vs. 76.1±8.3, P=0.54), sex (P=81), and laser status (P=0.75) were similar between the groups. Preoperatively, mean±SD logMAR VA (0.5±0.7 vs. 0.5±0.5, P=0.77), IOP (16.2±4.6 vs. 18.2±5.1, P=0.13), and Meds (1.4±1.1 vs. 1.3±0.7, P=0.75) were similar for phaco and PCP, respectively. At 24-month phaco (n=17) and PCP (n=11), respectively, mean±SD were: logMAR VA 0.2±0.2 versus 0.4±0.7, P=0.29; IOP 14.1±4.0 versus 12.9±3.8, P=0.43; and Meds 1.5±1.2 versus 0.3±0.5, P=0.005. Rates of successful IOP lowering without medications for phaco versus PCP at 12 months were 34% versus 75%, respectively (P=0.003).

Conclusions: A combination of canaloplasty with phaco results in a decreased number of glaucoma medications and increased survival rate of IOP-lowering effect compared with phaco alone.

*Department of Ophthalmology, Glaucoma Service, Eugene and Marilyn Glick Eye Institute, Indiana University School of Medicine, Indianapolis, IN

Department of Ophthalmology, Washington University, St Louis, MO

Design of the study: L.B.C., D.W., Y.C-B.; conduct of the study: S.N.A., L.B.C., D.W., G.R.P., Y.C-B., L.S.M., J.S.H.; data collection: S.N.A., G.R.P., L.S.M., J.S.H.; statistical analysis: D.W.; critical review of the manuscript: S.N.A., L.B.C., D.W., G.R.P., Y.C-B.; administrative support: L.S.M., J.S.H.

Supported, in part, by an unrestricted grant from Eugene and Marilyn Glick Eye Research Endowment for eye and vision research at the Indiana University Foundation.

Disclosure: L.B.C.: Allergan (consultant, research support); Alcon (research support); Pfizer (research support). D.W.: Prizer (consultant); Alcon (consultant). Y.C.-B.: Alcon (consultant). The remaining authors declare no conflict of interest.

Reprints: Louis B. Cantor, MD, Department of Ophthalmology, Glaucoma Service, Indiana University School of Medicine, Eugene and Marilyn Glick Eye Institute, 1160 West Michigan Street, Indianapolis, IN 46202 (e-mail:

Received March 3, 2012

Accepted September 11, 2012

© 2014 by Lippincott Williams & Wilkins.