VISUAL AND INTRAOCULAR PRESSURE CONTROL OUTCOMES AFTER MANAGEMENT OF OPEN-ANGLE GLAUCOMA WITH CATARACT SURGERY AND ISTENTS

To report a retrospective study regarding results obtained in patients with open-angle glaucoma treated by cataract surgery and iStent implantation.

Ophthalmology Department, University Hospital Ayr, Ayr, United Kingdom

Medical records of patients that underwent cataract surgery and iStent implantation by a single surgeon (A.I) from 2023 to 2024 at University Hospital Ayr were obtained. Patients were excluded if complete medical records were unavailable for data collection. Postoperatively, all subjects were treated with topical steroids for 4 weeks. There were 8 patients who underwent bilateral treatment, while 46 patients received treatment for only one eye. Data on visual acuity (VA), intraocular pressure (IOP), biometric parameters (axial length, anterior chamber depth, lens thickness), medication, gonioscopy, visual field stability, and retinal nerve fibre layer (RNFL) stability were recorded. Data on postoperative VA, IOP, visual field stability, RNFL stability, and medication were collected at 1 month, 3 months and after 3 months.

Full data on 61 eyes of 54 subjects was collected for analysis. There were no intraoperative complications. The mean preoperative VA was 0.32 logMar and the mean preoperative IOP was 21.24 mmHg. Preoperatively, the mean axial length was 23.47 mm, mean anterior chamber depth was 2.99 mm and mean lens thickness was 4.74 mm. There was a variable degree of narrowed angles on gonioscopy examination preoperatively. In 86.21% of the eyes, postoperative VF was stable and for 95.83% of the eyes the RNFL was stable. The mean postoperative VA was 0.42 logMar at 1 month, 0.10 logMar at 3 months, and 0.06 logMar after 3 months. The mean postoperative IOP was 16.58 mmHg at 1 month, 14.97 mmHg at 3 months, and 12.85 mmHg after 3 months. Of the 61 eyes, 18.03% (11 eyes) reduced their topical treatment, while 6.58% (4 eyes) discontinued their glaucoma treatment. All remaining eyes significantly reduced their IOP after the combined surgical procedure.

The management of open-angle glaucoma with cataract surgery and the use of iStents is an increasingly popular approach for patients who have both cataracts and glaucoma. This combined procedure is effective and safe for mild to moderate open-angle glaucoma, with relatively low risks, often reducing the need for medication without subjecting patients to high-risk surgeries.