Flarymetry measurement of blood-aqueous barrier breakdown after canaloplasty combined with phacoemulsification versus phacoemulsification in patients with secondary open angle glaucoma

Purpose
To evaluate the safety of canaloplasty with phacoemulsification compared to phacoemulsification in patients with pseudoexfoliative glaucoma and pigmentary glaucoma with respect to flaremetry measures.

Material and methods
Fifty-four eyes of patients with secondary open angle glaucoma who underwent canaloplasty with phaco­emulsification (Group 1) or phacoemulsification (Group 2) due to the cataract and uncontrolled glaucoma were enrolled. Flare was measured using the Laser Flare Meter Kowa FM-600 at baseline, and postoperatively – on day 7, as well as at 1, 3, 6, and 12 months. Other assessed outcome measures were intraocular pressure, number of glaucoma medications and adverse events.

Results
There was no significant difference in flare between Groups 1 and 2 at baseline (17.9 ± 7.9 ph/ms vs. 16.3 ± 6.0 ph/ms, p = 0.32). Similarly, there were no differences in flare between the groups at 1 week (p = 0.65) and 1 month (p = 0.25) post­operatively. The mean flare at 3, 6 and 12 months postoperatively was significantly lower in Group 1 (p<0.01). Postoperative intraocular pressure was lower in Group 1 at all measurement points (p<0.001). The number of antiglaucoma medications significantly decreased from baseline at all timepoints (p<0.001) only in eyes after phacocanaloplasty.

Conclusion
Phacocanaloplasty is a safe option for lowering intraocular pressure in patients with secondary open angle glaucoma as it ensures blood-aqueous barrier integrity. Flaremetry analyses demonstrated that combined surgery offers as high safety profile as the one of phacoemulsification.