Phacoemulsification with iStent® trabecular micro-bypass stents in complex and moderate-to-advanced glaucoma: three-year effectiveness and safety outcomes

Session Details

Session Title: Microinvasive Glaucoma Surgery

Session Date/Time: Sunday 15/09/2019 | 14:00-16:00

Paper Time: 15:42

Venue: Free Paper Forum: Podium 4

First Author: : G.Moussa UK

Co Author(s): :    P. Pandey   J. Panthagani   M. Kutubi   I. Masood                    

Abstract Details

Purpose:

There are many reports showing safe IOP and medication reduction with iStent® trabecular micro-bypass implants; however, there is limited evidence on the usage of the stents in complex and more advanced glaucoma. This study aims to evaluate long-term safety and IOP and medication reduction of two iStents implanted in combination with cataract surgery in patients with complex and moderate to advanced glaucoma who would otherwise have required more invasive glaucoma procedures.

Setting:

NHS Tertiary referral centre in Birmingham UK

Methods:

This retrospective interventional case series included patients with complex glaucoma of varied etiology and moderate to advanced disease requiring cataract surgery. Patients underwent implantation of two iStents in conjunction with cataract surgery. Outcome measures included intraocular pressure (IOP), glaucoma medication usage, visual field mean deviation, complications and need for secondary surgery.

Results:

Fifty consecutive patients with mean preoperative IOP of 24.2±7.3mmHg on a mean of 3.2±1.2 medications were included. Month-36 mean IOP was 16.2±4.3mmHg (33% reduction;p<0.05) and medication usage reduced to a mean of 2.1±1.1 medications (p<0.05). Overall VF-MD mildly worsened from -9.5 immediately post-op to -10.1 at M36 (p=0.08). Seven patients required filtration surgery due to disease progression and not related to the stents. No intraoperative complications were noted. An analyses of the cohort by preoperative IOP, advanced glaucoma, and prior filtration surgery is planned with an intent of reporting at the time of presentation.

Conclusions:

Trabecular micro-bypass implantation with iStent in combination with cataract surgery is a safe and effective option for patients with complex and moderate to advanced glaucoma. This study demonstrates sustained reduction of IOP, reduced dependence on pressure lowering drops, and stabilization of visual fields out to 3 years postoperative when utilizing the iStent implant in combination with phacoemulsification.

Financial Disclosure:

receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented