Posters

Reduction in intraocular pressure and glaucoma drops after standalone iStent inject® in pseudophakic eyes: 9–12 months' results

Poster Details

First Author: M.Pavel UK

Co Author(s):    A. Nagar   M. Nagar                 

Abstract Details

Purpose:

The primary aim of our study is to determine the reduction of Intraocular pressure (IOP) in pseudophakic eyes after ab-interno, gonioscopically guided implantation of two Glaukos iStent Injects in patients with coexisting pseudophakia and primary open angle glaucoma (POAG). Most of the patients were uncontrolled on glaucoma medications (72.22%) and 33.33% were non tolerant to glaucoma drops. The secondary aim of our study was to determine the reduction in glaucoma medications following iStent inject insertion.

Setting:

Prospective, non-comparative, uncontrolled, non-randomised, interventional case series study in patients with uncontrolled mild or moderate open-angle glaucoma or advanced glaucoma with non-tolerance to most or all glaucoma drops in pseudophakic eyes. Procedures performed by one surgeon (MN) at Pontefract General Hospital, Department of Ophthalmology, Mid Yorkshire Hospitals Trust, United Kingdom.

Methods:

18 pseudophakic eyes with POAG included. IOP was not within target range with glaucoma medications or they were nontolerant to drops.The mean age was 76.16 years, 61.11% male and 38.88% female. All patients underwent uneventful implantation of 2 iStent Injects through a single-entry point in the trabecular meshwork, nasal quadrant. Postoperative follow-up visits were planned at Day 1, Week 1 and months 1, 3, 6, 9 and 12. Out of 16 patients, 5.55% were on systemic Acetazolamide, discontinued on the day of surgery and the remaining ocular hypotensive medications were gradually washed off during postoperative visits depending on the IOP.

Results:

Mean IOP reduction from baseline was 6 mmHg (24.91%) at Day 1 decreasing to 20.30% at Month 9. The number of topical IOP lowering medications reduced from 2.44 drops at baseline to 1.87 at month 3, to 2.08 at Month 6 and again 2.44 drops at Month 9. At Month 12 visit, 20% IOP drop was achieved but no reduction was noticed in the number of glaucoma drops.Three patients ended up back on medication by 9 months of which 1 eye needed cyclodiode laser. A Patient Satisfaction Survey was also conducted of which results are consistent to our findings.

Conclusions:

IOP reduction was clinically and statistically significant in the early postoperative period: mean IOP reduction of more than 20% at Month 3 visit with 23.3% reduction in glaucoma drops. Implantation of iStent Inject as a Standalone procedure led to better IOP control but without reduction in glaucoma medications. One of the quoted outcome measures and benefits of Microinvasive Glaucoma Surgery (MIGS) is a significant reduction in medications owing to the problems with adherence. Although Standalone MIGS is gradually gaining popularity as a safe surgery being effective in reducing IOP,  long term follow-up and a larger patient group is required.

Financial Disclosure:

None