REAL WORLD CLINICAL OUTCOMES OF COMBINED PHACOEMULSIFICATION AND ISTENT® INFINITE TM BYPASS IMPLANTATION
Published 2025 - 29th ESCRS Winter Meeting
Reference: FP03.03 | Type: Free Paper | DOI: 10.82333/xtcv-qj24
Authors: Thomas Siempis* 1 , Devesh Varma 2 , Irfan Kherani 2 , Matthew Schlenker 2 , Iqbal Ike K. Ahmed 3
1Ophthalmology Department,St Luke’s Hospital,Thessaloniki,Greece;Mitropoleos 110 Street,Private Practice,Thessaloniki,Greece;School of Medicine, Dentistry & Nursing,University of Glasgow,Glasgow,United Kingdom, 2Prism Eye Institute,Oakville,Canada;Department of Ophthalmology and Vision Sciences,University of Toronto ,Toronto,Canada, 3Prism Eye Institute,Oakville,Canada;Department of Ophthalmology and Vision Sciences,University of Toronto ,Toronto,Canada;John Moran Eye Center ,University of Utah,Salt Lake City,United States
Purpose
Co‐existence of cataract and glaucoma is a common problem. Combined cataract surgery with Microinvasive Glaucoma Surgery offers the opportunity to enhance Intraocular Pressure (IOP) control and/or reduce the drops burden in this population. The iStent® InfiniteTM is the newer iteration of the iStent® trabecular micro-bypass implant. The aim of this study is to assess the clinical outcomes and adverse event data of combined phacoemulsification and iStent® InfiniteTM implantation in a heterogenous cohort of glaucoma patients.
Setting
Academic ophthalmology center in the Greater Toronto Area, Canada.
Methods
Single-center, retrospective interventional case series of consecutive patients that underwent combined phacoemulsification with iStent® InfiniteTM implantation between 15th of March 2023 and 31st of April 2024. All surgeries were performedby 4 attending surgeons and directly supervised clinical fellows. Exclusion criteria were eyes with less than 4 weeks of follow up. The primary endpoint was the success rate defined as the proportion of eyes with either medication reduction and no increase in IOP or 20% IOP reduction with the same or less medication at the most recent follow up. Secondary outcomes included the mean post-operative IOP and classes of drops at month 3, 6, 9 and 12, the mean last recorded uncorrected visual acuity (VA) as well as any complications or re-operations.
Results
56 eyes of 43 patients were identified. Mean age was 73.4 years. Mean follow up was 23.9 weeks. 35.7% of the eyes had a diagnosis of Primary Open Angle Glaucoma, 25% of Primary Angle Closure Glaucoma, 12.5% had Ocular Hypertension, 12.5% had Primary Angle Closure, 8.9% had Pseudoexfoliative Glaucoma and 5.4% had mixed mechanism glaucoma. 40% of the eyes with glaucomatous nerve damage had advanced glaucoma (visual field mean deviation (MD) of less than -12db or presence of central defects), 17% had moderate disease (MD between -6db and -12db) and 43% had mild disease (MD more than -6db). Mean pre-op IOP was 15.9mmHg on 1.7 drops. Mean pre-operative VA with the patients’ habitual refraction was 0.7 (LogMAR). 87.7% of eyes achieved the primary endpoint. Mean IOPs were 11.8mmHg on 0.6 drops, 12.1mmHg on 0.2 drops, 13.9mmHg on 0.5 drops and 13.4 on 1.2 drops in months 3, 6, 9 and 12 ,respectively (p<0.05 for both IOP and medication reduction from preop to all time points except POM9 and POM12 for medication reduction). Mean uncorrected last recorded VA was 0.3 (p<0.05). There were no intra-operative complications. 3 eyes developed an IOP spike in the first post operative month (range 26-35mmHg) that resolved with medical treatment and was attributed to steroid response. There were no other early post-op complications or re-operations.
Conclusion
Combined phacoemulsification with iStent® InfiniteTM implantation showed no serious adverse events with a high success rate and a clinically and statistically significant reduction in IOP and number of drops used up for at least 6 months following surgery.