Single-surgeon experience with ab interno trabecular micro-bypass stent implantation with concomitant cataract surgery in a predominantly Hispanic patient population with POAG: 2 year outcomes

Session Details

Session Title: Cataract Surgery & Glaucoma

Session Date/Time: Sunday 23/09/2018 | 14:00-16:00

Paper Time: 14:58

Venue: Room A3, Podium 1

First Author: : M.Gallardo USA

Co Author(s): :                        

Abstract Details

Purpose:

This case series aims to evaluate the outcomes of a single surgeon’s experience with a trabecular micro-bypass stent (iStent®) implanted in combination with cataract surgery to treat patients with POAG. As a result of the geographic location of the surgeon’s practice, this dataset is comprised of primarily Hispanic patients.

Setting:

Private single-surgeon ophthalmology practice in El Paso, Texas, USA.

Methods:

Consecutive series of 156 eyes classified by surgical goal into the following categories: a) IOP controlled with glaucoma medications (meds) and goal to reduce meds, b) IOP uncontrolled on meds and goal to reduce IOP, c) IOP uncontrolled on ≥3 meds and goal to reduce IOP and avoid glaucoma filtration surgery. All patients were implanted with one iStent during cataract surgery. To date, 104 eyes have been followed through two years. Most subjects were Hispanic (73%), 22% were Caucasian and 4% were African American. Medical/surgical history and preoperative/postoperative VF, RNFL, C/D ratio, IOP, medications, and complications/interventions were assessed.

Results:

Preoperative characteristics are: 57% moderate or severe glaucoma, VF MD –9.0±8.1 dB, IOP 16.8±4.0 mmHg, and 75% were taking 2 to 4 glaucoma meds. Mean postoperative IOP at year-2 was 12.6±1.8 mmHg with medication use eliminated in 50%. 95% of eyes had IOP ≤15 mmHg at 2 years. At year-2, VF and RNFL were observed to be stable (VF MD -9.0 vs. -8.1 dB, RNFL 78.2 vs. 78.8 µm (pre- and post-op, respectively)). By 2 years, 4 eyes categorized as severe, required a secondary surgery due to glaucoma progression. Overall, a low rate of complications was observed.

Conclusions:

In this case series comprised of primarily a Hispanic population with moderate to severe OAG, IOP and medication reduction were safely sustained through 2 years after implantation of a single iStent during cataract surgery. VF and RNFL remained stable over the course of 2 years following stent implantation.To our knowledge, this is the first report from a single-surgeon series where VF and RNFL is evaluated post-implantation of iStent. The results are encouraging in that VF and RNFL parameters remained essentially unchanged 2 years after stent implantation suggesting preservation of function and nerve structure in patients with glaucoma.

Financial Disclosure:

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