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Cataract surgery in chronic appositional angle-closure glaucoma alone versus associated with angle surgery using

M Cerdá Ibáñez1, N Burguera Giménez2, L Rial Álvarez3

  • 1Departamento de Glaucoma, Fundación de Oftalmología médica de la Comunidad Valenciana (FOM), Valencia, Spain.

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|March 1, 2026
PubMed
Summary

Phacoemulsification combined with trabecular surgery significantly lowers intraocular pressure (IOP) and medication needs in primary angle-closure glaucoma (PACG) patients compared to phacoemulsification alone. This combination therapy offers sustained IOP control over twelve months.

Keywords:
Cirugía mínimamente invasiva de glaucomaCirugía trabecularFacoemulsificaciónGlaucoma primario de ángulo abiertoGlaucoma primario de ángulo cerradoIntraocular pressureMinimally invasive glaucoma surgeryPhacoemulsificationPresión intraocularPrimary angle-closure glaucomaPrimary open-angle glaucomaTrabecular surgeryiStent

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Area of Science:

  • Ophthalmology
  • Glaucoma Research
  • Surgical Innovation

Background:

  • Primary angle-closure glaucoma (PACG) poses a significant risk to vision.
  • Managing intraocular pressure (IOP) is crucial for preventing glaucoma progression.
  • Phacoemulsification alone may not always achieve sufficient IOP reduction in PACG.

Purpose of the Study:

  • To compare the efficacy of phacoemulsification alone versus phacoemulsification with iStent implantation in managing IOP and medication requirements.
  • To evaluate long-term IOP control in patients with appositional primary angle-closure glaucoma.

Main Methods:

  • Retrospective cohort study of 28 eyes with appositional PACG.
  • Two groups: phacoemulsification only (phaco-only) and phacoemulsification with two iStent W inject trabecular stents (phaco-iStent).
  • Intraocular pressure (IOP) and medication counts recorded at baseline, and at 1, 6, and 12 months postoperatively.

Main Results:

  • No significant difference in IOP at one month postoperatively between groups.
  • The phaco-iStent group showed significantly lower IOP at six and twelve months.
  • Fewer hypotensive medications were required in the phaco-iStent group at twelve months.

Conclusions:

  • Combining phacoemulsification with trabecular surgery (iStent implantation) enhances long-term IOP reduction in appositional PACG.
  • This combined approach is more effective than phacoemulsification alone for sustained IOP control.
  • Consider trabecular surgery when phacoemulsification alone is unlikely to suffice for PACG management.