A study on outcome of second-generation iStent inject micro-bypass with cataract surgery

Session Details

Session Title: Presented Poster Session: Glaucoma I

Venue: Poster Village: Pod 3

First Author: : K.Suleiman UK

Co Author(s): :    R. Bafiq   T. Ressiniotis                    

Abstract Details

Purpose:

Glaucoma is one of the leading causes of visual impairment in the world. i-Stent inject is a second-generation micro bypass device which has two preloaded titanium stents in a single injector. Both stents are implanted two clock hours apart into the schlemm’s canal during cataract surgery in patients with mild to moderate open angle glaucoma (OAG). This minimally invasive glaucoma surgery (MIGS) lowers the intra ocular pressure (IOP) by reducing the resistance and improving the aqueous outflow bypassing the trabecular meshwork. We conducted a study to assess the outcome of i-Stent inject combined with cataract surgery.

Setting:

Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust,Birmingham,United Kingdom.

Methods:

All OAG patients who had combined cataract and i-Stent inject surgery from January 2018 to November 2018 by a single surgeon were included in the study. A retrospective review of their electronic case notes was performed. Data was recorded using Microsoft Excel and analysed by SPSS statistical package. Primary outcomes assessed were reduction of preoperative mean IOP and 20% reduction from baseline IOP. Secondary outcomes measured were reduction in number of anti-glaucoma medications and improvement in mean Logmar best corrected visual acuity (BCVA).

Results:

Thirty-one eyes of twenty-nine patients were included in the study. 62 % were female and 90% were Caucasians. Mean age of the study population was 76.6. The mean IOP decreased from 19.1 ± 4.2mmHg pre-op to 14.6 ± 2.2mmHg at four months post-op. 75% of patients had 20% reduction from mean baseline IOP. A drop in mean number of anti-glaucoma medications from 1.71 to 1.57 was noted. At the same time, mean BCVA improved from baseline 0.39 to 0.275 at four months. Two eyes had Cystoid macular oedema (CMO) and an equal number developed anterior uveitis.

Conclusions:

Mean IOP reduction was statistically significant in all post op visits compared to the pre-op IOP. Also, the results showed that the mean reduction of number of medications and improvement in BCVA were not statistically significant at any post-op visits. This study highlights that the i-Stent inject combined with cataract surgery was effective and safe. This surgery should be considered in phakic patients with mild to moderate open angle glaucoma  on polypharmacy, prior to contemplating further filtration or tube surgery. Further prospective study with long term follow up is warranted.

Financial Disclosure:

None