Refractive Outcomes Following Combined Cataract and Microinvasive Glaucoma Surgery

Purpose

To compare refractive outcomes in eyes undergoing cataract extraction (CE) alone, CE with goniotomy (CE/goniotomy), and CE with Schlemm’s canal stent (CE/SCS) insertion.

Design

Retrospective cohort study.

Participants

Eyes from the Bascom Palmer Glaucoma Repository undergoing CE/goniotomy, CE/SCS insertion, or uncomplicated CE alone between July 2014 and February 2022 were identified.

Methods

Refraction data were analyzed at postoperative month (POM) 1 and 6 with Kruskal–Wallis and Dunn’s tests. Anisometropia was defined as a spherical equivalent (SE) difference of ≥2D.

Main Outcome Measures

The primary outcome was mean refraction at POM1 and POM6 across the 3 surgical groups. Secondary outcomes were comparisons of refraction and visual acuity (VA) among different goniotomy and Schlemm’s canal stent (SCS) devices, as well as incidence of anisometropia.

Results

A total of 8360 eyes (150 CE/goniotomy, 395 CE/SCS, and 7815 CE alone) from 6059 patients were analyzed. At POM1, mean SE in the CE/goniotomy, CE/SCS, and CE alone groups was −0.36 ± 0.91D, −0.31 ± 0.85D, and −0.39 ± 0.88D respectively (P = 0.019). Mean logarithm of the minimum angle of resolution VA was 0.10 ± 0.20, 0.08 ± 0.19, and 0.14 ± 0.26 respectively (P = 0.002, CE/SCS vs. CE alone). No statistically significant differences were noted at POM6. Anisometropia occurred at POM1 in 2 patients (13.3%) in the CE/goniotomy-CE group, 1 patient (3.2%) in the CE/SCS-CE group, and 184 patients (4.9%) in the CE-CE group (P = 0.217). At POM6, mean SEs were −0.38 ± 0.97D (CE/goniotomy), −0.35 ± 0.81D (CE/SCS), and −0.40 ± 0.91D (CE alone; P = 0.473). No significant differences in overall refractive outcomes were observed with different SCS or goniotomy devices. Among primary open-angle glaucoma/normal-tension glaucoma eyes, mean SE at POM1 was −0.36 ± 0.73D (CE/goniotomy), −0.24 ± 0.84D (CE/SCS), and −0.45 ± 0.81D (CE alone; P < 0.001).

Conclusions

Concurrent SCS insertion or goniotomy with CE was associated with some statistically significant differences in postoperative refraction and VA, although these small magnitude differences were unlikely to be clinically meaningful.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found after the references in the Footnotes and Disclosures at the end of this article.