A Real World Comparison Of Istent Combined With Phacoemulsification And Endocyclophotocoagulation (Ice2) With Preserflo And Xen-45 Implants In The Uk Short- And Long-Term Outcomes.

its a real world comparison of iStent combined with phacoemulsification and endocyclophotocoagulation (ICE2) with PreserFlo and XEN-45 implants in the UK short- and long-term outcomes.

This report is a retrospective case series of patients undergoing either of the three MIGS procedures, with or without combined phacoemulsification surgery from July 2016 to May 2020 at Queen Victoria Hospital NHS Foundation Trust, United Kingdo

All patients attended a baseline visit prior to surgery. Clinical measurements at this visit included IOP using Goldmann Applanation Tonometry, visual field examination with Humphrey Field Analyser (Carl Zeiss Meditec, Dublin, CA), and best corrected visual acuity (BCVA) in LogMAR.  Detailed history was also recorded including number of anti-glaucoma medications, lens status, glaucoma type and patient demographics.

Patients were followed over a 2-year period with clinic visits scheduled at day 7, 1-month, 3-month, 6-month, 12-months, 18-months, and 24-months from the date of surgery. IOP, BCVA and number of medications were recorded at each visit, whereas visual fields were completed at 12-months and 24-months.

IOP reduction in ICE2, PMS and XEN-45 groups at 12-months was 4.6, 7.0, 5.6 mm Hg respectively. (27.2%) patients required five Fluro Uracil (5FU) injections in the PMS groups after 3-months. There were 4 (8.3%) occasions where bleb needling was required and 4 (8.3%) instances of bleb revision among PMS patients. In the XEN-45 group, ten (27%) patients underwent 5FU injections and a higher proportion (N= 12; 32%) required bleb needling. Bleb revision was comparable to PMS, and only one (2.7%) patient needed replacement of XEN with PMS.on the other hand ICE2 procedure did not require any further manipulations.

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This retrospective review demonstrates the clinical effectiveness and safety profile of PMS, XEN-45 and ICE2. PMS showed the maximum effect in reducing IOP among patients with more severe stage disease. ICE2 was associated with fewer post-operative complications compared to PMS and XEN-45 but is typically performed in patients with less severe visual field damage using fewer anti-glaucoma medications. PMS was associated with fewer post-operative bleb manipulations compared with XEN-45 after 24-months, suggesting it is advisable to warn patients undergoing XEN-45 about the likelihood of repeated intervention.