AIM:To evaluate the efficacy and safety of femtosecond laser assisted phacoemulsification combined with Ahmed glaucoma drainage valve implantation in the treatment of cataract complicated with refractory glaucoma.

METHODS: Retrospective case-control study. From October 2019 to October 2021, 53 cataract patients(53 eyes)with refractory glaucoma were divided into 26 cases(26 eyes)in the femtosecond laser assisted cataract surgery(FLACS)group and 27 cases(27 eyes)in the conventional phacoemulsification surgery(CPCS)group according to their voluntary choice. The two groups underwent FLACS and CPCS combined with Ahmed glaucoma drainage valve implantation separately. The differences of intraoperative phacoemulsification energy(CDE), effective phacoemulsification time(EPT)and the changes of the number of anti glaucoma drugs before and after operation were compared between the two groups, and the effects of improving best corrected visual acuity(BCVA), reducing intraocular pressure, the degree of damage to corneal endothelial cells, the surgical complications and success rate were observed and compared between the two groups in different follow-up periods(1d,1wk, 1 and 3mo).

RESULTS: The intraoperative CDE and EPT in FLACS group were significantly lower than those in CPCS group(t=8.50, 5.16; P<0.01, P=0.001). The postoperative anti glaucoma drugs in the two groups were significantly less than those before operation(t=9.12, 7.76; P=0.011, 0.016), but there was no significant difference between the two groups(t=1.79, P=0.082).The postoperative BCVA of the two groups all improved and the intraocular pressure was all lower than that before operation(P<0.05).The improvement of BCVA in FLACS group was more significant than that in CPCS group in the early postoperative period(1d, 1wk; t=9.74, 8.49; P=0.008, 0.012), but there was no significant difference in the improvement degree of BCVA at 1 and 3mo after operation(t=0.62, 0.44; P=1.415, 2.021). The damage to corneal endothelial cell in CPCS group was more obvious than that in FLACS group at different stages of postoperative follow-up(P<0.05). There was no significant difference in controlling intraocular pressure between FLACS group and CPCS group at different stages of postoperative follow-up(F_interblock=0.64, P_interblock=0.421). The incidence of surgical complications was 27%(7/26)in FLACS group, which was lower than the 89%(24/27)in CPCS group(χ²=20.95, P<0.01). Corneal edema(8% vs. 41%), anterior capsular tear(0 vs. 11%)were significantly lower in FLACS group than in CPCS group. Posterior capsule rupture(0 vs. 7%), vitreous prolapse(0 vs. 4%)and intraocular lens deviation(0 vs. 7%)also occurred in CPCS group. However, the total success rate of the two groups was similar(P=28.718).

CONCLUSION: Femtosecond laser assisted phacoemulsification combined with Ahmed glaucoma drainage valve implantation can give full play to the precise, minimally invasive and controllable advantages of the combined operation to help patients effectively reduce intraocular pressure and recover vision earlier.