Comparing Outcomes of Phacoemulsification and Endocyclophotocoagulation with Either Dual Blade Goniotomy (PEcK) or Two Trabecular Stents (ICE2)

Abstract

Purpose

To compare outcomes of phacoemulsification and endocyclophotocoagulation with either dual blade goniotomy (PEcK) or two trabecular stents (ICE2).

Setting

Retrospective, nonrandomized comparative study from a level 3 triage center.

Methods

One hundred and seventy charts and a total of 1294 visits were reviewed following either PEcK or ICE2 from 2018 to 2022. One hundred and twenty-eight patients had PEcK and 42 underwent ICE2. Patients with less than 30 days of follow-up were excluded. The mean follow-up time was 505 ± 308 days. Two Kaplan–Meier curves (KM) assessed survival with ≤ baseline medications while maintaining (1) [GIC – Goal IOP Criteria] IOP ≤ goal IOP or (2) [PRC – Percent Reduction Criteria] IOP reduction ≥ 20% with 5 mmHg ≤ IOP ≤ 21 mmHg for at least two consecutive visits. IOP and medication burden reduction were compared using a paired t-test.

Results

Most patients were Caucasian (65%) and had mild-stage glaucoma (43%). The most common glaucoma type was primary open-angle glaucoma (58%). Average age was 72.2 years at the time of surgery. Mean preoperative IOP was 17.58 ± 4.98 mmHg on 3.00 ± 1.41 medications in PEcK and 15.36 ± 3.58 mmHg on 1.81 ± 1.11 medications in ICE2 (p = 0.015 for IOP; p < 0.001 for medications). Under GIC, the success rate was significantly higher in PEcK at POM6 (69% vs 46%, p < 0.001) and POY1 (63% vs 36%, p < 0.001). Under PRC, the success rate was significantly higher in PEcK at POM6 (73% vs 61%, p = 0.031) and POY1 (67% vs 50%, p = 0.028). Mean reductions at POY1 were 5.00 ± 4.31 mmHg on 1.35 ± 1.08 less medications after PEcK and 3.14 ± 2.83 mmHg on 1.01 ± 0.94 less medications after ICE2 (p < 0.001 at POY1 for IOP; p < 0.05 after POW6 for medications).

Conclusion

Both PEcK and ICE2 reduce medication and IOP from baseline, with PEcK having more favorable GIC and PRC success rates and greater IOP and medication reduction at 1 year.

Keywords:

• microinvasive glaucoma surgery
• phacoemulsification
• endocyclophotocoagulation
• Kahook Dual Blade
• iStent inject
• surgical outcomes

Data Sharing Statement

De-identified data are available upon reasonable request to corresponding authors.

Acknowledgments

The authors are grateful to Mr. and Mrs. Charles and Anne Gifford (Concord, Massachusetts, USA), Mr. and Mrs. Joseph and Cathey S. Leitch (Charleston, South Carolina, USA), as well as the Sinskey Foundation (Los Angeles, California, USA) for their generous donations that supported this research. Meeting presentation at The European Society of Cataract and Refractive Surgeons, Messe Wien Exhibition and Congress Center, Vienna, Austria, September 8–12, 2023.

Disclosure

D. Solá-Del Valle received financial support from Allergan, an AbbVie company, for giving lectures related to the XEN Gel Stent in 2021, a device that is unrelated to this study. The authors report no other conflicts of interest in this work.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or for-profit sectors.