Purpose: To compare the surgical outcomes of combined corneal-incision cataract surgery and viscocanalostomy (phaco-VCS) with or without the adjunctive peeling of juxtacanalicular tissue (JCT) in 136 patients of open-angle glaucoma or ocular hypertension.
Methods: In a prospective clinical trial, 63 eyes underwent phaco-VCS (Peeling (-) group), and 73 eyes underwent phaco-VCS with the peeling of JCT (Peeling (+) group). The postoperative IOP, the probability of successful IOP reduction without medications, and postoperative complications were compared between the two groups.
Results: The mean preoperative IOP of 19.9 +/- 3.3 (+/-SD) mm Hg in the Peeling (-) group decreased significantly to 13.9 +/- 6.8 at 3 days, 14.6 +/- 3.1 at 12 months, and 15.5 +/- 2.3 mm Hg at 24 months. The IOP of 20.2 +/- 3.2 mm Hg in the Peeling (+) group decreased significantly to 11.4 +/- 5.1 at 3 days, 14.9 +/- 3.0 at 12 months, and 15.9 +/- 2.1 mm Hg at 24 months. There was no significant difference in IOP levels between the two groups (P >/= 0.1512) except for the IOP level at 3 postoperative days (P = 0.0265). The probabilities of achieving IOPs without medications under 21 mm Hg and 15 mm Hg at 24 months in the Peeling (-) groups were 61.0% and 10.4%, and those in the Peeling (+) group were 61.7% and 23.9% (P >/= 0.4389). The incidences of IOP spike more than 30 mm Hg (7.9%) and fibrin formation (15.8%) in the Peeling (-) group were higher than in the Peeling (+) group (0%; P = 0.0195, 5.5%; P = 0.1907). Slit-lamp microscopic hyphema, which included red blood cells in the anterior chamber was observed in about half, and bleb formation more than 1 month was less than 5% in both groups.
Conclusion: Postoperative IOPs were significantly decreased in both groups. Although the peeling of JCT was not enhanced in long-term reduction of the IOP, it lowered IOP at postoperative 3 days and the incidence of IOP spike. The adjunctive procedure would be beneficial to glaucoma patients in phaco-VCS.