One year outcome of combined phacoemulsification and insertion of an Ab interno implanted trabecular micro-bypass in patients with ocular hypertension or glaucoma: efficacy, complications and visual outcomes
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First Author: S.Georgoulas UK
Co Author(s): G. Agorogiannis A. Vlavianos J. Clarke
This retrospective study assessed the 12-month visual outcomes, effectiveness, and safety of iStent® or iStent inject® trabecular micro-bypass implant with cataract surgery in patients with ocular hypertension (OHT) or glaucoma.
Glaucoma Service, Moorfields Eye Hospital NHS Trust, UK
Parameters analysed were age at date of surgery, gender, ethnic origin, diagnosis, previous treatments, implant type, visual acuity, intraocular pressure (IOP) and number of glaucoma agents at time points pre-operatively, 1 week, 4-6 weeks, 3, 6 and 12 months post op, Humphrey Mean Deviation (MD) at time points pre-op and 12 months post-op.
70 patients and 82 eyes were operated for phacoemulsification with iStent® or iStent inject® from Apr 2017 to Aug 2018. 58 patients underwent 1 eye surgery and 12 bilateral. Sample was predominantly female (55 eyes), Caucasian (24 eyes) with mean age 75.27±6.46years. 71 eyes hadn’t previous glaucoma operation, 6 had iridotomies, 3 selective laser trabeculoplasty, and 2 trabeculectomies. Diagnosis was mainly POAG (43 eyes) or OHT (17 eyes). 43 eyes were implanted with the iStent®, 36 with iStent inject® and in 3 type of stent wasn't recorded. 73 eyes didn't have intraoperative complications and 5 had significant hyphema obscuring the view (resulting in abandoning insertion in 1 case). In 2 eyes the insertion was abandoned without hyphema. In 1 eye iris cleft was caused. In 1 case the second implant did not release. MD(24-2 SITA Fast) of eyes undergone cataract + iStent/iStent inject® improved during studied period (from -6.67±5.72dB pre-op to -5.83±6.00dB 12 months post-op, p=0.047). IOP was found reduced in all time points; mean IOP pre-op was 17.49mmHg reduced to 15.27 @1 week (p<.001), 15.41 @4-6 weeks (p=.002), 13.88 @3 months (p<.001), 14.62 @6 months (p<0.001) and 14.78 @12 months (p<.001).
Glaucoma agents were reduced at all time points; mean number of medication used was 1.89 pre-operatively, 1.48 at time point 1 week post-operatively (p=.002), 1.18 @week 4-6 (p=.001), 1.24 @3 months (p=.083), 1.60 @6 months (p=.080) and 1.51 @12 months (p=.016). 2 patients needed trabeculectomy. In our cohort study combined phacoemulsification with iStent® or iStent inject® implantation achieved reduction of IOP and glaucoma medications with visual function improvement and safe profile.
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