Mechanical trabecular peeling in the treatment of patients with primary open-angle glaucoma
https://doi.org/10.53432/2078-4104-2026-25-2-55-62
Abstract
PURPOSE. To evaluate the clinical effectiveness of combined mechanical trabecular peeling and phacoemulsification (PE) in patients with primary open-angle glaucoma (POAG) and complicated cataract.
METHODS. The study included 72 patients (72 eyes) with POAG and complicated cataract (46 women, 26 men). Early stage POAG was present in 52 (72.2%) eyes, and moderate stage POAG in 20 (27.7%) eyes.
Patients were divided into two groups. In the main group (37 patients, 37 eyes), subjects underwent mechanical trabecular peeling combined with phacoemulsification and intraocular lens (IOL) implantation. The control group (35 patients, 35 eyes) underwent isolated phacoemulsification with IOL implantation.
Baseline intraocular pressure (IOP) measured by Maklakov tonometry was 23 [19; 24] mm Hg in the main group and 23 [21.0; 25.0] mm Hg in the control group (p=0.553). The number of hypotensive medications used preoperatively was 2 [0; 4] in the main group and 2 [0; 3] in the control group (p=0.135). The follow-up period was 12 months.
RESULTS. At 12 months, IOP in the main group was 18.0 [18.0; 20.0] mm Hg with complete discontinuation of hypotensive therapy. In the control group, IOP was 20.0 [19.5; 22.5] mm Hg, with additional hypotensive therapy required in 9% of cases. The reduction in IOP from baseline was 15.37% in the main group and 11.46% in the control group (p=0.031). A significant difference between groups was observed in the ease of outflow coefficient (p=0.007).
CONCLUSION. The developed combined technique of phacoemulsification with mechanical trabecular peeling results in a 15.37% reduction in IOP from baseline at 12 months postoperatively, exceeding the hypotensive effect of isolated PE. The method is associated with a minimal risk of complications and may be recommended for the treatment of patients with early and moderate POAG and complicated cataract.
About the Authors
O. G. Makarova
Cheboksary branch of the S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery"
Russian Federation
Russian Federation
ophthalmologist at the Glaucoma Department
10 Traktorostroiteley Ave., Cheboksary, 428048
N. Yu. Gorbunova
Cheboksary branch of the S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery" ; Postgraduate Doctors Training Institute of the Ministry of Public Health of the Chuvash Republic
Russian Federation
Russian Federation
Cand. Sci. (Med.), Head of the Glaucoma Department, Associate Professor at the Academic Department of Surgery with a Course of Ophthalmology
10 Traktorostroiteley Ave., Cheboksary, 428048
27 Mikhaila Sespelya St., Cheboksary, 428003
A. A. Voskresenskaya
Cheboksary branch of the S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery" ; Postgraduate Doctors Training Institute of the Ministry of Public Health of the Chuvash Republic
Russian Federation
Russian Federation
Cand. Sci. (Med.), Deputy Director for Scientific Work, Associate Professor at the Academic Department of Surgery with a Course of Ophthalmology
10 Traktorostroiteley Ave., Cheboksary, 428048
27 Mikhaila Sespelya St., Cheboksary, 428003
N. A. Pozdeyeva
Cheboksary branch of the S.N. Fedorov National Medical Research Center "MNTK "Eye Microsurgery" ; Postgraduate Doctors Training Institute of the Ministry of Public Health of the Chuvash Republic
Russian Federation
Russian Federation
Dr. Sci. (Med.), Director, Professor at the Academic Department of Surgery with a Course of Ophthalmology
10 Traktorostroiteley Ave., Cheboksary, 428048
27 Mikhaila Sespelya St., Cheboksary, 428003
References
1. Kiseleva OA, Robustova OV, Bessmertny AM, Zakharova EK, et al. Prevalence of primary glaucoma in representatives of different races and ethnic groups in russia and in CIS. Ophthalmology in Russia 2013; 10(4):11-15. https://doi.org/10.18008/1816-5095-2013-4-11-15
2. Natsional’noe rukovodstvo po glaukome dlya praktikuyuschikh vrachei [National Glaucoma Guidelines for Practitioners]. Eds. Egorov E.A., Erichev V.P. Moscow, GEOTAR-Media Publ., 2019. 384 р.
3. Komarova NG. Possibilities of antiglaucoma lens surgery: on the 30th anniversary of the GREVE operation. Modern technologies in ophthalmology 2018;(3):75-78.
4. Poley BJ, Lindstrom RL, Samuelson TW. Long-term effects of phacoemulsification with intraocular lens implantation in normotensive and ocular hypertensive eyes. J Cataract Refract Surg 2008; 34(5):735-742. https://doi.org/10.1016/j.jcrs.2007.12.045.
5. Berdahl JP. Cataract surgery to lower intraocular pressure. Middle East Afr J Ophthalmol 2009; 16(3):119-122. https://doi.org/10.4103/0974-9233.56222
6. Hayashi K, Hayashi H, Nakao F, Hayashi F. Effect of cataract surgery on intraocular pressure control in glaucoma patients. J Cataract Refract Surg. 2001; 27(11):1779-1786. https://doi.org/10.1016/s0886-3350(01)01036-7
7. Thomas R, Walland M, Thomas A, Mengersen K. Lowering of Intraocular Pressure After Phacoemulsification in Primary Open-Angle and Angle-Closure Glaucoma: A Bayesian Analysis. Asia Pac J Ophthalmol (Phila) 2016; 5(1):79-84. https://doi.org/10.1097/APO.0000000000000174
8. Majstruk L, Leray B, Bouillot A, Michée S, et al. Long term effect of phacoemulsification on intraocular pressure in patients with medically controlled primary open-angle glaucoma. BMC Ophthalmol 2019; 19(1):149. https://doi.org/10.1186/s12886-019-1157-3
9. Kochergin SA, Alexeev IB, Yashina LV, et al. The role of single-stage phacoemulsification combined with cyclodialysis «ab interno» in the treatment of cataract and primary open-angle glaucoma. RMJ Clinical Ophthalmology 2008; 3:104-107.
10. Lapochkin AV, Neroev VV, Lapochkin VI. A new way of surgical treatment of primary glaucoma in the eyes with cataract is fermentative trabeculocleaning. Surgical technique. Cataract and refractive surgery 2012; 4: 23-25.
11. Trubilin VN, Caira NA. A new combined method of one-stage phacoemulsification and vacuum trabeculoplasty ab interno. Ophthalmology in Russia 2014; 11(1):28-37.
12. Brandão LM, Grieshaber MC. Update on Minimally Invasive Glaucoma Surgery (MIGS) and New Implants. J Ophthalmol 2013; 2013:705915. https://doi.org/10.1155/2013/705915.21.
13. Reiss G, Clifford B, Vold S, He J, et al. Safety and Effectiveness of CyPass Supraciliary Micro-Stent in Primary Open-Angle Glaucoma: 5-Year Results from the COMPASS XT Study. Am J Ophthalmol 2019; 208:219-225. https://doi.org/10.1016/j.ajo.2019.07.015.
14. Mosaed S. Minimally invasive glaucoma surgery and CyPass Micro-Stent – a new era in glaucoma surgery. US Ophthalmic Review 2017; 10(1):39-41. https://doi.org/10.17925/USOR.2017.10.01.3
15. Maluygin B.E., Sokolovskaya T.V., Magaramov D.A., Volodin PL, et al. Yag-laser activation of trabecula in combined treatment of primary open-angle glaucoma and coexisting complicated cataract. Ophthalmosurgery 2021; 2:85-92. https://doi.org/10.25276/0235-4160-2020-2-85-92.
16. Rumyantsev AD, Slonimsky AY, Tsvetkov SA, Estrin LG. Activation of trabecular outflow of aqueous humor with Nd: YAG laser in patients with primary open-angle glaucoma before phacoemulsification. Cataract and refractive surgery 2011; 11(1):36-40.
17. Abrosimova EV, Aksenov VP, Balalin SV, Dzhashi BG, et al. The use of selective laser trabeculoplasty and phacoemulsification of cataract in the treatment of primary open-angle glaucoma with pseudoexfoliation syndrome. Glaucoma news 2016; 1:59.
18. Fedorov SN, Egorova EV. Oshybki i oslozhneniya pri implantatsii iskustvennogo hrustalica [Errors and complications in artificial lens implantation]. Moscow, Medicine Publ., 1992. 244 p.
19. Gorbunova NA, Makarova OG, Pozdeeva NA. Sposob odnomomentnogo khirurgicheskogo lecheniya glaukomy i oslozhnennoj katarakty putem mekhanicheskogo trabekuloklininga ab interno. Patent RU 2810177, 19.04.2023. https://new.fips.ru/registers-doc-view/fips_servlet. Date of access: 23.10.2025.
20. Gorbunova NA, Makarova OG, Pozdeeva NA. Instrument dlya mekhanicheskogo trabekuloklininga pri kombinirovannom lechenii glaukomy i oslozhnennoj katarakty. Patent RU na poleznuyu model' 221450, 19.04.2023. https://new.fips.ru/registers-doc-view/fips_servlet. Date of access: 23.10.2025.
21. Zolotaryov AV. Mikrokhirurgicheskaya anatomiya drenazhnoi sistemy glaza [Microsurgical anatomy of the eye drainage system]. Samara, 2009. 63 p.
22. Nesterov AP. Primary open-angle glaucoma: pathogenesis and principles of treatment. RMJ Clinical Ophthalmology 2000; 1:4.
23. Makarova OG, Ostrovsky DS, Kerimov TZ, Borzenok SA. et al. Morphological study of the drainage system of the eyeball after performing mechanical trabeculoplasty ab interno. Oftalmologičeskie vedomosti. 2025; 18(3):33-42. https://doi/com/https://doi.org/10.17816/OV643384
24. Ivanov DI, Nikulin ME. Trabeculotomy ab interno as a hypotensive component in a combined surgery of a cataract with a glaucoma. Natsional'nyi zhurnal glaukoma 2011; 3:34-38.
25. Trubilin VN, Haira NA. Novel method of combined phacoemulsification and vacuum trabeculoplasty ab interno. Ophthalmology in Russia 2014; 11(1):28-37.
Review
For citations:
Makarova O.G., Gorbunova N.Yu., Voskresenskaya A.A., Pozdeyeva N.A. Mechanical trabecular peeling in the treatment of patients with primary open-angle glaucoma. National Journal glaucoma. 2026;25(2):55-62. (In Russ.) https://doi.org/10.53432/2078-4104-2026-25-2-55-62
Views:
97
JATS XML
Email this article 