CO(2) Laser-Assisted Sclerectomy Surgery Alone or Combined with Phacoemulsification in Primary Open-Angle Glaucoma: Comparison of 1-Year Outcomes

INTRODUCTION: To compare 1-year outcomes of CO(2) laser-assisted sclerectomy surgery (CLASS) alone or combined with phacoemulsification (CLASS + Phaco) in eyes with primary open-angle glaucoma (POAG). METHODS: This was a prospective, comparative, case series study. A total of 46 eyes with POAG underwent CLASS or CLASS + Phaco were followed up for 1 year. The primary outcomes included changes in intraocular pressure (IOP), medication and best corrected visual acuity (BCVA). The secondary outcomes were success rate, functional bleb, postoperative laser intervention and complications. RESULTS: CLASS alone resulted in a greater IOP reduction compared with CLASS + Phaco. BCVA improved remarkably in CLASS + Phaco group, but there was no difference in BCVA before and after CLASS. The number of antiglaucoma medications significantly decreased at 12 months postoperatively in both groups. Functional blebs were more commonly seen in the CLASS than combination group. The overall success rate was higher in the CLASS than CLASS + Phaco group at 1 year after surgery. The incidence of peripheral anterior synechiae (PAS) in CLASS + Phaco group was significantly lower than that of CLASS alone. CONCLUSION: CLASS alone achieved a greater IOP reduction, more common functional bleb formation and a higher success rate compared to CLASS combined with Phaco, while combination surgery yielded a better BCVA improvement and a lower PAS incidence than CLASS alone. Both surgical strategies have favorable safety and efficacy among POAG patients. Combined surgery could be a viable option for patients with co-existing POAG and cataract. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40123-022-00539-2.