Combined Phacoemulsification and 360-Degree Suture Trabeculotomy Ab Externo in Primary Chronic Angle Closure Glaucoma: A Modified Technique

Purpose: To assess the outcome of combined phacoemulsification and 360-degree suture trabeculotomy ab externo in chronic angle closure glaucoma using a modified technique. Methods: This is a retrospective clinical study that included 60 eyes of 60 patients who had undergone combined phacoemulsification and 360-degree suture trabeculotomy ab externo for the treatment of primary chronic angle closure glaucoma. The patients were divided into two groups. The first group (ab externo group) and the second group (modified ab externo group). Data were collected from the records and the final follow-up visit including age, sex, intraocular pressure (IOP), number of antiglaucoma medications, presence of complications, corrected distant visual acuity, and need for another intervention. All the included patients completed at least 12 months follow-up. Results: The ab externo group included 30 patients and the modified ab externo group included 30 patients. The postoperative IOP was reduced in both groups significantly from the preoperative levels. The percent of reduction was around 60% for both groups (59.5% for the ab externo group and 59.3% for the modified ab externo group). There was statistically significant reduction in the mean amount of required topical medications after the intervention for both groups (p = 0.001). Most of the complications were not serious. Around 90% of the cases in both groups had mild degree of grade 1 hyphema. Conclusion: Both ab externo 360 degree suture trabeculotomy and its modified technique with ab interno pulling of the suture when combined with phacoemulsification are safe and provide adequate decrease in the intraocular pressure. Modified technique of ab interno pulling of the prolene suture might be more gentle procedure with less severe hyphema and lower chance of rupture of trabeculo-Descemet's membrane.