ABSTRACT
PURPOSE: To compare refractive outcomes in eyes undergoing cataract extraction (CE) alone, CE with goniotomy (CE/goniotomy), and CE with Schlemm's canal stent (CE/SCS) insertion. DESIGN: Retrospective cohort study. PARTICIPANTS: Eyes from the Bascom Palmer Glaucoma Repository undergoing CE/goniotomy, CE/SCS insertion, or uncomplicated CE alone between July 2014 and February 2022 were identified. METHODS: Refraction data were analyzed at post-operative month (POM) 1 and 6 with Kruskal-Wallis and Dunn's tests. Anisometropia was defined as a spherical equivalent (SE) difference of ≥2D. MAIN OUTCOME MEASURES: The primary outcome was mean refraction at POM1 and POM6 across the three surgical groups. Secondary outcomes were comparisons of refraction and visual acuity among different goniotomy and SCS devices, as well as incidence of anisometropia. RESULTS: A total of 8,360 eyes (150 CE/goniotomy, 395 CE/SCS, and 7,815 CE alone) from 6,059 patients were analyzed. At POM1, mean SE in the CE/goniotomy, CE/SCS, and CE alone groups was -0.36±0.91D, -0.31±0.85D, and -0.39±0.88D respectively (p=0.019). Mean logMAR VA was 0.10±0.20, 0.08±0.19, and 0.14±0.26 respectively (p=0.002, CE/SCS vs. CE alone). No statistically significant differences were noted at POM6. Anisometropia occurred at POM1 in 2 patients (13.3%) in the CE/goniotomy-CE group, 1 patient (3.2%) in the CE/SCS-CE group, and 184 patients (4.9%) in the CE-CE group (p=0.217). At POM6, mean SEs were -0.38±0.97D (CE/goniotomy), -0.35±0.81D (CE/SCS), and -0.40±0.91D (CE alone; p=0.473). No significant differences in overall refractive outcomes were observed with different SCS or goniotomy devices. Among primary open-angle glaucoma (POAG) / normal-tension glaucoma (NTG) eyes, mean SE at POM1 was -0.36±0.73D (CE/goniotomy), -0.24±0.84D (CE/SCS), and -0.45±0.81D (CE alone; p<0.001). CONCLUSIONS: Concurrent SCS insertion or goniotomy with CE was associated with some statistically significant differences in postoperative refraction and visual acuity, although these small magnitude differences were unlikely to be clinically meaningful.
