Outcomes of combined surgical treatment of glaucoma and cataract in complicated cases

PURPOSE. To evaluate the effectiveness and safety of combined surgical treatment for primary open-angle glaucoma (POAG) and cataract in patients with grade I–II lens subluxation due to pseudoexfoliation syndrome (PEX). The study analyzed early outcomes of phacoemulsification (PE) with optic capture fixation of the intraocular lens (IOL) and non-penetrating deep sclerectomy (NPDS) using the Healaflow drainage in the presence of zonular weakness.

METHODS. The study included 20 patients (20 eyes) with stage II–III POAG, age-related cataract, and grade I–II lens subluxation associated with PEX. All patients (mean age 73 years) underwent simultaneous phacoemulsification with implantation of an AcrySof MA60AC IOL (Alcon) using the optic capture technique and NPDS with Healaflow. Uncorrected (UCVA) and best-corrected visual acuity (BCVA), intraocular pressure (IOP), tonographic parameters, static perimetry, and optical coherence tomography (OCT) findings were evaluated over 12 months.

RESULTS. At 12 months, UCVA improved from 0.07±0.06 to 0.35±0.22 (p<0.001), and BCVA increased from 0.26±0.19 to 0.68±0.23 (p<0.001). IOP decreased from 26.4±6.6 mm Hg to 16.7±5.1 mm Hg (p<0.001), with 90% of patients not requiring hypotensive therapy. The aqueous outflow facility coefficient (C) increased by 75%, while the minute volume (F) decreased by 28%. OCT confirmed IOL stability (tilt 6.55±2.71°, decentration 0.44±0.14 mm). The mean deviation (MD) decreased by 14%, and the pattern standard deviation (PSD) decreased by 20%.

CONCLUSION. The combined approach to the treatment of POAG, cataract, and lens subluxation associated with PEX provided sustained IOP reduction, improved visual function, and maintained IOL stability. The optic capture technique proved effective for IOL fixation in cases with zonular weakness, while NPDS with Healaflow ensured safe glaucoma control. Further long-term studies with larger cohorts are warranted to confirm these findings.

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