Anterior Chamber Angle Changes and Surgical Outcomes After Combined Phacoemulsification and High-Frequency Deep...

Postoperative AS-OCT evaluation after combined phacoemulsification and HFDS revealed specific AS-OCT angle parameters correlated with surgical success, supporting its role as a potential imaging biomarker for long-term glaucoma surgery follow-up.

To evaluate postoperative anterior segment optical coherence tomography (AS-OCT) parameters following combined high-frequency deep sclerotomy (HFDS) and phacoemulsification surgery and to assess their relationship with intraocular pressure (IOP) reduction and medication use over an 18-month period.

This prospective observational study included 75 eyes of patients with primary open angle glaucoma (POAG) or pseudoexfoliation glaucoma (PEX) who underwent combined phacoemulsification and HFDS. AS-OCT imaging was performed between 1 and 18 months postoperatively to measure angle-opening distance (AOD500/750), trabecular-iris space area (TISA500/750), and scleroconjunctival complex thickness (SCT). The presence of episcleral hyporeflective spaces (EHS) was also recorded. Surgical success was defined as complete (IOP ≤21 mm Hg, ≥20% reduction, without medication) or qualified (with medication).

Mean IOP decreased significantly from 16.8±4.0 mm Hg to 14.2±2.9 mm Hg at 18 months, with a marked reduction in medication use. Complete success was achieved in 65.3% of eyes. Postoperative AS-OCT showed generalized widening of the anterior chamber angles. Measurements at 500 µm were not associated with IOP outcomes, whereas some 750 µm parameters-particularly nasal AOD750-showed variable associations with IOP reduction depending on outcome definitions and pressure change magnitude. SCT and EHS did not differ between outcome groups. No significant differences were found between POAG and PEX eyes, and AS-OCT parameters remained stable throughout follow-up.

Combined phacoemulsification and HFDS provides sustained IOP reduction and medication decrease over 18 months. AS-OCT shows postoperative angle widening and suggests that 750 µm posterior angle measurements may reflect surgical outcomes.