Autologous Anterior Lens Capsule as an Intrascleral Spacer in Deep Sclerectomy: A Randomized Clinical Trial
In brief
A lens-capsule spacer lowered eye pressure by 1.3 mmHg at 12 months
In a randomized trial of 60 eyes with glaucoma and cataracts, adding a patient's own lens capsule during combined surgery lowered average eye pressure to 12 mmHg at 12 months, versus 13.3 mmHg without the spacer. More eyes met a strict pressure target, but medication differences were not statistically clear and longer-term results remain unknown.
- Journal
- American journal of ophthalmology (Q1)
- Published
- 27 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Neda Einollahi, Azadeh Doozandeh, Javad Rezaei, Mohammadmehdi Hatami, Kimia Alborzi, Kiana Hassanpour, et al.
- PMID
- 42946033
- DOI
- 10.1016/j.ajo.2026.10.023
Why clinicians should know about it
- Picked for Ophthalmology (paper of the day, 28 October 2026): Randomized trial of a glaucoma surgical technique
Abstract
OBJECTIVE: To compare deep sclerectomy (DS) combined with phacoemulsification (PE), with versus without an autologous anterior lens capsule spacer. DESIGN: Prospective, randomized, parallel-group clinical trial. METHODS: Sixty eyes of 60 adults with medically uncontrolled glaucoma and visually significant cataracts underwent PE-DS with an autologous anterior capsule spacer (Spacer group) or PE-DS alone (Control group). Follow-up was at least 12 months. The primary outcome was change in intraocular pressure (IOP) from baseline through 12 months. Secondary outcomes included glaucoma medication use, surgical success according to prespecified IOP-based criteria, and adverse events. RESULTS: Baseline IOP was similar (25.14 ± 9.62 vs 23.77 ± 5.18 mmHg) and both study groups had significant IOP reduction at all visits. IOP was significantly lower in the spacer group at month 6 (11.90 ± 1.82 vs 13.13 ± 2.20 mmHg; P = 0.022) and month 12 (12 ± 2.20 vs 13.29 ± 2.68 mmHg; P = 0.042). Medication use was lower in eyes with an autologous spacer at months 6 (0.14 ± 0.45 vs 0.48 ± 0.85; P= 0.063) and 12 (0.29 ± 0.66 vs 0.68 ± 1.04; P =0.094). Under stringent success definitions, survival favored the spacer (e.g., Definition C: IOP≤12 mmHg: 47.5% vs 15.5%; log-rank test P = 0.025). CONCLUSIONS AND RELEVANCE: Adding an autologous anterior capsule spacer during PE-DS was associated with lower IOP at 6 and 12 months and higher cumulative success under stringent IOP thresholds. Medication use was lower in the spacer group, although the between-group differences showed a trend toward statistical significance.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.