Real-World Outcomes of Combined Phacoemulsification and STREAMLINE

Purpose: To report the clinical outcomes of a novel ab interno minimally invasive procedure with the STREAMLINE Methods: In a retrospective analysis of all consecutive cases performed and followed for up to 12 months, 51 eyes of 51 subjects with mild, moderate, and severe primary open-angle glaucoma (POAG) underwent canaloplasty and incisional goniotomy following phacoemulsification cataract extraction. The procedure was performed according to the manufacturer's instructions for use. However, in contrast to other studies where the technique involved solely incisional goniotomy during viscoelastic delivery, in this study, a 1-2 clock hour goniotomy was created with the cannula after 3-6 injections of viscoelastic into Schlemm's canal. Outcomes in this interim analysis included mean reduction in IOP and medications through month 12, as well as the proportion of eyes achieving IOP reduction ≥20% from baseline. Results: Mean preoperative IOP was 16.9 mmHg using a mean of 1.2 medications (n = 51). At 30 days post-op, mean IOP was 15.3 mmHg using a mean of 0.2 medications; 21.6% (11/51) had IOP reduction ≥20% from baseline; 90.2% (46/51) were medication-free. At 6 months post-op, mean IOP was 15.6 mmHg using a mean of 0.2 medications; 21.6% (11/51) had IOP reduction ≥20% from baseline; 90.2% (46/51) were medication-free. At 12 months post-op, mean IOP was 17.0 mmHg using a mean of 0.2 medications, 37.3% (19/51) had IOP reduction ≥20% from baseline; 88.2% (45/51) were medication-free. No adverse events were reported. No secondary surgical interventions were required in any patient. Conclusion: Canaloplasty and incisional goniotomy combined with phacoemulsification safely and effectively reduced dependence on IOP-lowering medications while adequately managing IOP in eyes with primary open-angle glaucoma through 12 months of follow-up.