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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              

Abstract Details

Purpose:

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.

Setting:

Glaucoma Service, Moorfields Eye Hospital NHS Trust, UK

Methods:

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.

Results:

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).

Conclusions:

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.

Financial Disclosure:

... receives consulting fees, retainer, or contract payments from a competing company