1
|
Mitchell W, Yang SA, Ondeck C, Stewart I, Zhao Y, Roldan AM, Halawa O, Hall N, Elze T, Miller J, Lorch A, Zebardast N. Effectiveness of Angle-Based Minimally Invasive Glaucoma Surgery after Laser Trabeculoplasty: An Analysis of the IRIS® Registry (Intelligent Research in Sight). Ophthalmol Glaucoma 2024:S2589-4196(24)00048-6. [PMID: 38519027 DOI: 10.1016/j.ogla.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/04/2024] [Accepted: 03/14/2024] [Indexed: 03/24/2024]
Abstract
OBJECTIVE Angle-based minimally invasive glaucoma surgery (ab-MIGS) has grown substantially, although long-term efficacy is poorly understood. We analyze ab-MIGS effectiveness with and without preceding laser trabeculoplasty (LTP). DESIGN Retrospective cohort study. SUBJECTS Eyes undergoing ab-MIGS (Canaloplasty, Goniotomy, Trabectome, and iStent) with and without prior laser trabeculoplasty (< 2 years preceding MIGS) were identified in the IRIS® Registry (Intelligent Research in Sight) 2013 to 2018. METHODS Propensity score matching (PSM) was undertaken to define the following 4 cohorts: (1) standalone ab-MIGS, no prior LTP vs. (2) standalone ab-MIGS, with prior LTP; and (3) ab-MIGS + phacoemulsification, no prior LTP vs. (4) ab-MIGS + phacoemulsification, with prior LTP. MAIN OUTCOME MEASURES Failure was defined as subsequent glaucoma reoperation after ab-MIGS (either MIGS or traditional glaucoma surgery). Time-to-event outcome and incidence rates were calculated using survival analysis, and adjusted hazard ratios (aHRs) were generated using multivariate Cox proportional hazards models. Medication data were not available for analysis. RESULTS A total of 164 965 unique MIGS procedures were performed, from 2013 to 2018. After PSM, we identified 954 eyes undergoing standalone ab-MIGS and 7522 undergoing ab-MIGS + phacoemulsification. For eyes undergoing standalone ab-MIGS, those with prior LTP (n = 477) were more likely to undergo reoperation vs. those without LTP (n = 477) at 6 and 12 months. In multivariable models, those with prior LTP were more likely to undergo reoperation over the 36-month period vs. those without prior LTP (aHR, 1.53; CI, 1.15-2.04; P = 0.004). For eyes undergoing ab-MIGS + phacoemulsification, those with prior LTP (n = 3761) were more likely to undergo reoperation vs. those without LTP (n = 3761) at 12, 24, and 36 months. In multivariable models, those with prior LTP were more likely to undergo reoperation over the 36-month period vs. those without prior LTP (aHR, 1.53 CI, 1.15-2.04; P = 0.004). CONCLUSIONS Prior LTP may be associated with a higher chance of subsequent glaucoma surgery following ab-MIGS, either with or without concurrent phacoemulsification. These findings have important implications for understanding who may benefit most from ab-MIGS, and for guiding patient and surgeon treatment expectations. FINANCIAL DISCLOSURES Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Collapse
Affiliation(s)
- William Mitchell
- Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts; Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Shuang-An Yang
- Harvard TH Chan School of Public Health, Boston, Massachusetts; Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Courtney Ondeck
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts; Glaucoma Service, Massachusetts Eye and Ear, Boston, Massachusetts; Harvard Medical School, Department of Ophthalmology, Boston, Massachusetts
| | | | - Yan Zhao
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Ana M Roldan
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts; Glaucoma Service, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Omar Halawa
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts; Harvard Medical School, Department of Ophthalmology, Boston, Massachusetts
| | - Nathan Hall
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Tobias Elze
- Glaucoma Service, Massachusetts Eye and Ear, Boston, Massachusetts; Schepens Eye Research Institute, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Joan Miller
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts; Glaucoma Service, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Alice Lorch
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts; Glaucoma Service, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Nazlee Zebardast
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts; Glaucoma Service, Massachusetts Eye and Ear, Boston, Massachusetts; Harvard Medical School, Department of Ophthalmology, Boston, Massachusetts.
| |
Collapse
|
2
|
Morita S, Sakanishi Y, Riyu I, Watanabe S, Ebihara N. Comparative evaluation of iStent versus iStent inject W combined with phacoemulsification in open angle glaucoma. PLoS One 2024; 19:e0297514. [PMID: 38315707 PMCID: PMC10843132 DOI: 10.1371/journal.pone.0297514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 12/29/2023] [Indexed: 02/07/2024] Open
Abstract
PURPOSE The study aimed to compare the 12-month post-operative outcomes of iStent and iStent inject W (inject W), and the factors associated with their success in open-angle glaucoma. METHODS This single-center, retrospective comparative case series evaluated the medical records of patients who underwent iStent (comprising 1 stent) or inject W (comprising 2 stents) implantation with cataract surgery for primary open-angle glaucoma and normal tension glaucoma between January 2019 and March 2022. The 12-month post-operative efficacy outcomes included intraocular pressure (IOP), glaucoma medications, and survival analysis of the probability of success. "Failure" was defined as any of the following conditions compared to baseline: 1) IOP elevation, 2) increased glaucoma medication, or 3) IOP decline not exceeding 20% when glaucoma medication scores were comparable, and 4) need for additional glaucoma surgery. The safety outcomes included intra- and post-operative adverse events and changes in the best-corrected visual acuity and visual field. RESULTS The study comprised 55 eyes in the iStent and 105 in the inject W groups. At 12 months, treatment success was achieved in 66.0% of iStent and 78.4% of inject W eyes. The mean IOP was lower, and the percent reduction from baseline was equal in iStent-treated eyes (8.0% reduction, 14.8 mmHg to 13.7 mmHg, P<0.01) and inject W-treated eyes (11.9% reduction, 15.0 mmHg to 13.8 mmHg, P<0.01) (between-group comparison, P = 0.23). The mean medication burden decreased significantly from 2.5 to 1.1 for iStent (55.0% reduction, P<0.01) and 2.9 to 1.7 for iStent inject (46.8% reduction, P<0.01), with no significant differences between the two groups (P = 0.17). Both devices exhibited excellent safety. CONCLUSIONS Both devices significantly reduced IOP and glaucoma medication 12 months post-operatively. The outcome measures did not differ significantly between the two groups, and lower baseline IOP was predictive of surgical failure.
Collapse
Affiliation(s)
- Shuu Morita
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Tiba, Japan
| | - Yoshihito Sakanishi
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Tiba, Japan
| | - Ikari Riyu
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Tiba, Japan
| | - Satoshi Watanabe
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Tiba, Japan
| | - Nobuyuki Ebihara
- Department of Ophthalmology, Juntendo University Urayasu Hospital, Tiba, Japan
| |
Collapse
|
3
|
Bedrood S, Berdahl J, Sheybani A, Singh IP. Alternatives to Topical Glaucoma Medication for Glaucoma Management. Clin Ophthalmol 2023; 17:3899-3913. [PMID: 38111854 PMCID: PMC10726774 DOI: 10.2147/opth.s439457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 11/22/2023] [Indexed: 12/20/2023] Open
Abstract
Topical glaucoma medications have favorable safety and efficacy, but their use is limited by factors such as side effects, nonadherence, costs, ocular surface disease, intraocular pressure fluctuations, diminished quality of life, and the inherent difficulty of penetrating the corneal surface. Although traditionally these limitations have been accepted as an inevitable part of glaucoma treatment, a rapidly-evolving arena of minimally invasive surgical and laser interventions has initiated the beginnings of a reevaluation of the glaucoma treatment paradigm. This reevaluation encompasses an overall shift away from the reactive, topical-medication-first default and a shift toward earlier intervention with laser or surgical therapies such as selective laser trabeculoplasty, sustained-release drug delivery, and micro-invasive glaucoma surgery. Aside from favorable safety, these interventions may have clinically important attributes such as consistent IOP control, cost-effectiveness, independence from patient adherence, prevention of disease progression, and improved quality of life.
Collapse
Affiliation(s)
| | | | - Arsham Sheybani
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
- Department of Ophthalmology and Visual Sciences, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | | |
Collapse
|
4
|
Radcliffe NM, Shah M, Samuelson TW. Challenging the "Topical Medications-First" Approach to Glaucoma: A Treatment Paradigm in Evolution. Ophthalmol Ther 2023; 12:2823-2839. [PMID: 37855977 PMCID: PMC10640619 DOI: 10.1007/s40123-023-00831-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/29/2023] [Indexed: 10/20/2023] Open
Abstract
Topical glaucoma medications are effective and safe, but they have numerous well-documented limitations that diminish their long-term utility and sustainability. These limitations can include high rates of nonadherence (with associated glaucoma progression), concerning side effects, inconsistent circadian intraocular pressure (IOP) control, complex dosing regimens, difficulty with self-administration, costs, and decreased quality of life. Despite these limitations, topical medications traditionally have been first-line in the glaucoma treatment algorithm, as no other minimally invasive treatment alternatives existed. In recent years, however, novel interventional therapies-including sustained-release drug-delivery platforms, selective laser trabeculoplasty, and micro-invasive glaucoma surgery procedures-have made it possible to intervene earlier without relying on topical medications. As a result, the topical medication-first treatment approach is being reevaluated in an overall shift toward earlier more proactive interventions.
Collapse
Affiliation(s)
- Nathan M Radcliffe
- New York Eye Surgery Center, 1101 Pelham Parkway North, Bronx, NY, 10469, USA.
| | - Manjool Shah
- New York University (NYU) Langone Health, New York, NY, USA
| | - Thomas W Samuelson
- Minnesota Eye Consultants, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
5
|
Ruparelia S, Wilson D, Shoham-Hazon N. Hemi-GATT combined with phacoemulsification in patients with moderate-severe primary open-angle glaucoma: 2-year outcomes. Graefes Arch Clin Exp Ophthalmol 2023; 261:3257-3262. [PMID: 37421482 DOI: 10.1007/s00417-023-06166-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/20/2023] [Accepted: 06/28/2023] [Indexed: 07/10/2023] Open
Abstract
PURPOSE To describe the outcomes of inferior hemisphere 180° gonioscopy-assisted transluminal trabeculotomy (hemi-GATT) in patients with moderate-severe stage primary open-angle glaucoma (POAG). METHODS This single center, retrospective study identified patients with POAG who had undergone combined inferior hemi-GATT with phacoemulsification. Patients with moderate-severe staged POAG were included in the study. Outcome measures included surgical success, intraocular pressure (IOP), number of topical IOP-lowering drops, best-corrected visual acuity (BCVA), visual field mean deviation (MD) and complications. Success was defined using two criteria: Criterion A (IOP <17 mmHg and >20% reduction) and Criterion B (IOP <12 mmHg and >20% reduction). RESULTS One hundred-twelve eyes of 112 patients were included in this study. Of these, 91 patients were followed for 24 months or greater to assess endpoint surgical success. Kaplan-Meier survival analysis for Criterion A demonstrated a 64.8% probability of success without topical IOP-lowering therapy (complete success) and a 93.4% probability of success with or without topical IOP-lowering therapy (qualified success). Probabilities of complete and qualified success using Criterion B were 26.4% and 30.8%, respectively. IOP reduction from baseline (21.9 ± 5.8 mmHg) to 24-month follow-up (13.6 ± 3.9 mmHg) was 37.9% for the overall cohort. The most common complication was transient hyphema, which occurred in 25.9% (29 of 112) of patients. All cases of hyphema resolved spontaneously. CONCLUSIONS Combined hemi-GATT with phacoemulsification was associated with favorable outcomes and a low complication rate in this study of patients with moderate-severe POAG. Further studies are required comparing hemi-GATT to the 360° approach.
Collapse
Affiliation(s)
- Sunil Ruparelia
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Darcie Wilson
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Nir Shoham-Hazon
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Miramichi EyeNB Centre of Excellence, Miramichi, New Brunswick, Canada
| |
Collapse
|
6
|
Balas M, Mathew DJ. Minimally Invasive Glaucoma Surgery: A Review of the Literature. Vision (Basel) 2023; 7:54. [PMID: 37606500 PMCID: PMC10443347 DOI: 10.3390/vision7030054] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/24/2023] [Accepted: 08/17/2023] [Indexed: 08/23/2023] Open
Abstract
Minimally invasive glaucoma surgery (MIGS) has emerged as a novel approach in the glaucoma treatment spectrum, offering a range of diverse procedures and devices aimed at reducing intraocular pressure (IOP). MIGS can be broadly classified into several categories: those that enhance trabecular outflow (Trabectome, iStent, Hydrus Microstent, Kahook Dual Blade, high frequency deep sclerotomy, and gonioscopy-assisted transluminal trabeculotomy), those that augment suprachoroidal outflow (CyPass Microstent and iStent Supra), those that target Schlemm's canal (TRAB360 and the OMNI Surgical System, Streamline, and Ab Interno Canaloplasty), and conjunctival bleb-forming procedures (EX-PRESS Glaucoma Filtration Device, Xen Gel Stent and PreserFlo MicroShunt). MIGS is considered to have a shorter surgical time and fewer severe complications when compared to traditional glaucoma surgeries such as trabeculectomy and glaucoma drainage device implantation (Ahmed, Baerveldt, and Molteno valves). This literature review comprehensively examines the distinct MIGS devices and procedures, their underlying mechanisms, and clinical outcomes, emphasizing the importance of evaluating the efficacy and complications of each approach individually. As the field of MIGS continues to evolve, it is crucial to prioritize high-quality, long-term studies to better understand the safety and effectiveness of these innovative interventions in glaucoma management.
Collapse
Affiliation(s)
- Michael Balas
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada;
| | - David J. Mathew
- Donald K. Johnson Eye Institute, Krembil Research Institute, University Health Network, Toronto, ON M5T 0S8, Canada
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON M5T 2S8, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
| |
Collapse
|
7
|
Gallardo MJ, Porter M. Efficacy and Safety of Pairing iStent Inject Trabecular Micro-Bypass and iAccess Precision Blade Goniotomy in Patients with Open-Angle Glaucoma. Ophthalmol Ther 2023; 12:1973-1987. [PMID: 37178443 PMCID: PMC10287603 DOI: 10.1007/s40123-023-00726-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
INTRODUCTION This study evaluated efficacy and safety of implanting two second-generation trabecular micro-bypass stents (iStent inject/iStent inject W) with phacoemulsification, either with or without iAccess Precision Blade goniotomy, in patients with mild-to-moderate open-angle glaucoma (OAG). METHODS This retrospective, non-randomized, unmasked, dual-arm, single-site, multi-surgeon, consecutive case series evaluated all OAG eyes that underwent phacoemulsification and iStent inject implantation either as a dual procedure (group A) or paired with iAccess goniotomy (group B) from July 2020 to May 2022. Effectiveness outcomes analyzed from 1 month onward included intraocular pressure (IOP), proportions of eyes with IOP ≤ 12/≤ 15/≤ 18, proportion medication-free, and medication number. Safety outcomes at all timepoints included adverse events and secondary surgeries. RESULTS In group A, mean IOP reduced from 14.9 ± 3.2 mmHg on 1.22 ± 1.31 mean medications preoperatively (n = 63) to 13.5 ± 2.5 mmHg on 0.24 ± 0.61 medications at month 3 (n = 34; p = 0.048 IOP, p < 0.001 medications). In group B, mean IOP reduced from 16.0 ± 4.2 mmHg on 1.12 ± 1.07 medications preoperatively (n = 93) to 12.2 ± 2.3 mmHg on 0.57 ± 1.27 medications at month 3 (n = 23; p < 0.001 IOP, p = 0.003 medications). From preoperative to 3 months, the percent of eyes with IOP ≤ 12 mmHg remained at 32.4% in group A (p = 1.0) and rose from 21.7% to 60.9% in group B (p = 0.0177); eyes with IOP ≤ 15 mmHg rose from 52.9% to 76.5% in group A (p = 0.0963) and from 43.5% to 91.3% in group B (p = 0.0034). Adjusting for baseline between-group differences, group B had significantly greater postoperative IOP reduction than group A (p = 0.043); medication reductions were similar. Safety was favorable in both groups. CONCLUSIONS Phacoemulsification and iStent inject with or without iAccess Precision Blade goniotomy produced clinically meaningful and safe IOP and medication reductions. The paired iStent inject + iAccess + phacoemulsification procedure enabled greater IOP reduction and lower IOP thresholds than iStent inject + phacoemulsification. The study provides some of the first data on this paired approach and on the novel iAccess Precision Blade.
Collapse
Affiliation(s)
- Mark J. Gallardo
- El Paso Eye Surgeons, PA, 1201 North Mesa Street, Suite G, El Paso, TX 79902 USA
- Department of Ophthalmology, Texas Tech University Health Sciences Center in Lubbock, 3601, 4th St, Lubbock, TX 79430 USA
| | - Matthew Porter
- El Paso Eye Surgeons, PA, 1201 North Mesa Street, Suite G, El Paso, TX 79902 USA
- Department of Ophthalmology, Texas Tech University Health Sciences Center in Lubbock, 3601, 4th St, Lubbock, TX 79430 USA
| |
Collapse
|
8
|
Yuasa Y, Hirooka K, Okada N, Onoe H, Murakami Y, Okumichi H, Kiuchi Y. Vision-Related Quality of Life following Combined Cataract and Minimally Invasive Glaucoma Surgery or Cataract Surgery Alone in Glaucoma Patients. J Clin Med 2023; 12:jcm12093279. [PMID: 37176719 PMCID: PMC10179390 DOI: 10.3390/jcm12093279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 04/30/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023] Open
Abstract
This study examined glaucoma patients after undergoing combined cataract and minimally invasive glaucoma surgery (MIGS), microhook ab interno trabeculotomy and goniotomy with the Kahook Dual Blade (KDB), or cataract surgery alone, and it then evaluates their vision-related quality of life (VR-QOL) following the procedure. A total of 75 eyes of 75 consecutive glaucoma patients in this prospective cohort study underwent phacoemulsification (Phaco) or phaco and MIGS (Phaco-TLO) between October 2019 and March 2022. In all cases, the National Eye Institute Visual Function Questionnaire (VFQ-25) was used to evaluate the 20 eyes in the Phaco group and the 55 eyes in the Phaco-TLO group before and at 2 months after surgery. There was a significant increase in the visual acuity (logMAR) at 2 months post-operatively (Phaco group; 0.34 ± 0.10 to -0.07 ± 0.1, p < 0.0001, Phaco-TLO group; 0.37 ± 0.43 to 0.09 ± 0.32, p < 0.0001). The median (25-75th percentile) total VFQ scores in the Phaco group before and at 2 months after surgery were 71.1 (62.4-80.6) and 79.4 (69.0-84.0), respectively. (p = 0.006). The median (25-75th percentile) total VFQ scores in the Phaco-TLO group before and at 2 months after surgery were 69.8 (55.3-78.6) and 74.7 (65.1-83.3), respectively. (p = 0.005). Glaucoma patients who underwent not only cataract surgery alone but also combined cataract surgery and MIGS exhibited significant improvement in the VR-QOL.
Collapse
Affiliation(s)
- Yuki Yuasa
- Department of Ophthalmology and Visual Science, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
- Department of Ophthalmology, Hiroshima Prefectural Hospital, 1-5-54 Ujinakanda, Minami-ku, Hiroshima 734-8530, Japan
| | - Kazuyuki Hirooka
- Department of Ophthalmology and Visual Science, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Naoki Okada
- Department of Ophthalmology and Visual Science, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Hiromitsu Onoe
- Department of Ophthalmology and Visual Science, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Yumiko Murakami
- Department of Ophthalmology and Visual Science, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
- Department of Ophthalmology, Hiroshima Prefectural Hospital, 1-5-54 Ujinakanda, Minami-ku, Hiroshima 734-8530, Japan
| | - Hideaki Okumichi
- Department of Ophthalmology and Visual Science, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| | - Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Science, Hiroshima University Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
| |
Collapse
|
9
|
Kounatidou NE, Filippopoulos T, Palioura S. Ab Interno Goniotomy with the Kahook Dual Blade in a Monocular Patient with Mucous Membrane Pemphigoid and Refractory Open Angle Glaucoma: A Case Report. Int Med Case Rep J 2022; 15:563-568. [PMID: 36313053 PMCID: PMC9604402 DOI: 10.2147/imcrj.s382810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/29/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose To describe the case of a monocular patient with ocular mucous membrane pemphigoid (MMP) and open angle glaucoma refractory to medical treatment, who was successfully managed with ab interno goniotomy at the time of cataract surgery. Methods A 63-year-old woman with a history of severe MMP presented with exacerbation of the disease in both eyes. Vision was 20/80 in the right eye and light perception in the left eye. Symblepharon formation, trichiasis and forniceal foreshortening were present in the right eye, while the cornea of the left eye was completely conjunctivalized. Following aggressive systemic immunosuppressive therapy with corticosteroids and cyclophosphamide, the disease was brought under control. However, the patient developed a mature cataract and high intraocular pressure (IOP) of 28 mmHg on maximal medical therapy. Due to the high risk of ocular MMP exacerbation with glaucoma filtration surgery, the decision was made to proceed with cataract extraction combined with ab interno goniotomy with the Kahook Dual Blade. Results There were no intraoperative complications. The IOP has remained in the 12–14 mmHg range without any topical glaucoma medications over a total follow up of 3.5 years. Conclusion Ab interno goniotomy using the Kahook Dual Blade can significantly reduce IOP and medication burden in MMP cases, where any type of conjunctival incisional surgery could induce disease flare up. In this case, it represented a safe and effective surgical procedure for ocular MMP with concomitant refractory open angle glaucoma.
Collapse
Affiliation(s)
| | | | - Sotiria Palioura
- Department of Ophthalmology, University of Cyprus Medical School, Nicosia, Cyprus,Correspondence: Sotiria Palioura, 7 Lampsa Str, Athens, 11524, Greece, Tel +30 698 580 2355, Email
| |
Collapse
|
10
|
Albuainain A, Al Habash A. Three-year clinical outcomes of phacoemulsification combined with excisional goniotomy using the kahook dual blade for cataract and open-angle glaucoma in Saudi Arabia. Saudi J Ophthalmol 2022; 36:213-217. [PMID: 36211318 PMCID: PMC9535918 DOI: 10.4103/sjopt.sjopt_182_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 03/08/2022] [Accepted: 04/18/2022] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The aim of this study was to describe the changes in intraocular pressure (IOP), IOP-reducing drugs, and visual acuity (VA) through up to 3 years of follow-up in patients undergoing combined phacoemulsification and excisional goniotomy with the Kahook Dual Blade (KDB-phaco) by a single surgeon in Saudi Arabia. METHODS The health records of 55 eyes of 47 patients undergoing KDB-phaco by a single surgeon were reviewed. Data were extracted from visits occurring preoperatively (n = 55), intraoperatively (n = 55), and 1-day (n = 55), 2 weeks (n = 55), 4-6 weeks (n = 49), 2-3 months (n = 55), and 6 (n = 55), 9 (n = 55), 12 (n = 55), 18 (n = 49), 24 (n = 46), and 36 months (n = 16) postoperatively. Data collection included IOP, IOP-lowering medications, and VA at each time point. Adverse events were also collected. Paired t-tests were used to compare IOP, medications, and VA at each time point to preoperative values. RESULTS Mean (standard error) baseline IOP was 20.4 (0.7) mmHg and through up to 36 months of follow-up (minimum 12 months, mean 26.1 [1.0] months) ranged from 13.6 to 14.1 mmHg; significant reductions (P < 0.0007) of 5.7-7.0 mmHg (23.0%-29.5%) were achieved at every time point. Medications were reduced from 3.2 (0.1) to 0.2-2.0 (reductions of 1.2-3.1 medications [50.0%-94.9%]; P < 0.0001 at every time point). At months 24 and 36, the mean IOP was 13.9 (0.3) and 13.9 (0.5) mmHg and mean medications were 1.4 (0.2) and 2.0 (0.4). Mean logMAR VA improved from 1.0 (0.1) preoperatively to (0.2 [0.0]; P < 0.001) by month 6 and remained stable thereafter through the duration of follow-up. CONCLUSION KDB-phaco significantly lowered IOP approximately 30% by day 1 with consistency and durability through 3 years. Medication use was reduced by >50% through 36 months. Mean logMAR VA improved from 1.0 to 0.2 (Snellen equivalent 20/200-20/32). This procedure provides meaningful long-term reductions in IOP and the need for IOP-lowering medications without compromising visual rehabilitation in Saudi Arabian eyes with cataract and glaucoma.
Collapse
Affiliation(s)
- Abdulrahman Albuainain
- Eye and Laser Centre, Bahrain Defense Force Hospital, Royal Medical Services, Riffa, Kingdom of Bahrain,Address for correspondence: Abdulrahman Albuainain, Eye and Laser Center, Bahrain Defence Force Hospital, Royal Medical Services, Military Hospital, Riffa, Kingdom of Bahrain. E-mail:
| | - Ahmed Al Habash
- Department of Ophthalmology, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Kingdom of Saudi Arabia
| |
Collapse
|
11
|
Mechleb N, Tomey K, Cherfan D, Nemr A, Cherfan G, Dorairaj S, Khoueir Z. Six months' follow-up of combined phacoemulsification-kahook dual blade excisional goniotomy. Saudi J Ophthalmol 2022; 36:195-200. [PMID: 36211310 PMCID: PMC9535917 DOI: 10.4103/sjopt.sjopt_151_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 02/25/2022] [Accepted: 03/21/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE This study reports on the combination of excisional goniotomy and cataract extraction in the management of glaucoma in terms of intraocular pressure (IOP) and glaucoma medication reduction. METHODS This is a retrospective case series. Twenty-eight eyes of 22 patients with the diagnosis of cataract and ocular hypertension or glaucoma of any stage underwent combined phacoemulsification and Kahook Dual Blade (KDB) goniotomy, between March 2019 and September 2020. The parameters evaluated were postoperative best-corrected visual acuity, mean IOP reduction, number of IOP-lowering medications, and the surgical success rate defined as IOP reduction >20% and/or reduction in glaucoma medications >1. RESULTS The mean IOP reduction at 6 months was 4.5 mmHg (P = 0.0007), which translates to 24.9% reduction from preoperative IOP. The mean preoperative number of glaucoma medications was 2.9 ± 1.0 (median of 3). It was reduced to 1.1 ± 1.1 (median of 1.5), 1.46 ± 1.17 (median of 2), 1.44 ± 1.28 (median of 2), and 1.56 ± 1.28 (median of 2) at 1 week, 1 month, 3 months, and 6 months, respectively. Twenty-nine percent (8/28) of the patients were off glaucoma medications at 6 months and 46% (13/28) had a reduction of more than 50% of their glaucoma medications. CONCLUSION Combined phacoemulsification-KDB excisional goniotomy may be an effective and safe alternative to more invasive filtering surgery in glaucoma patients of any stage.
Collapse
Affiliation(s)
- Nicole Mechleb
- Faculty of Medicine, Saint-Joseph University, Byblos, Lebanon,Department of Glaucoma, Beirut Eye and ENT Specialist Hospital, Byblos, Lebanon
| | - Karim Tomey
- Department of Glaucoma, Beirut Eye and ENT Specialist Hospital, Byblos, Lebanon,Lebanese American University, Gilbert and Rose-Mary Chagoury School of Medicine, Byblos, Lebanon
| | - Daniel Cherfan
- Department of Glaucoma, Beirut Eye and ENT Specialist Hospital, Byblos, Lebanon
| | - Antony Nemr
- Faculty of Medicine, Saint-Joseph University, Byblos, Lebanon
| | - Georges Cherfan
- Faculty of Medicine, Saint-Joseph University, Byblos, Lebanon,Department of Glaucoma, Beirut Eye and ENT Specialist Hospital, Byblos, Lebanon
| | - Syril Dorairaj
- Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida, USA
| | - Ziad Khoueir
- Faculty of Medicine, Saint-Joseph University, Byblos, Lebanon,Department of Glaucoma, Beirut Eye and ENT Specialist Hospital, Byblos, Lebanon,Department of Ophthalmology, Mayo Clinic, Jacksonville, Florida, USA,Address for correspondence: Dr. Ziad Khoueir, Department of Glaucoma, Beirut Eye and ENT Specialist Hospital, Hotel Dieu Street, Mathaf Square, 116-5311, Beirut, Lebanon. E-mail:
| |
Collapse
|
12
|
iStent inject Trabecular Micro-Bypass with or Without Cataract Surgery Yields Sustained 5-Year Glaucoma Control. Adv Ther 2022; 39:1417-1431. [PMID: 35113323 PMCID: PMC8918186 DOI: 10.1007/s12325-021-02039-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 12/23/2021] [Indexed: 11/05/2022]
Abstract
Introduction This study evaluated the 5-year effectiveness and safety of iStent inject® trabecular micro-bypass with or without cataract surgery (Combined or Standalone, respectively) in patients with open-angle glaucoma (OAG). Methods This prospective longitudinal case series included consecutive iStent inject cases from a single surgeon at a large German academic hospital. Intraocular pressure (IOP), medications, safety, and indicators of disease stability through 5 years were assessed in the Overall cohort and in subgroup analyses stratified by usage (Combined or Standalone). Results Preoperative mean IOP in the Overall cohort (n = 125) was 23.5 ± 6.2 mmHg on 2.68 ± 1.02 mean medications, reducing to 14.1 ± 1.8 mmHg on 0.77 ± 0.82 medications at 5 years (40% and 71% reductions, respectively; both p < 0.001). All but 1 eye (> 99%) were on medication(s) preoperatively, but 46% were medication-free at 5 years (p < 0.001). In Combined eyes (n = 81), mean IOP decreased by 39% (22.6 mmHg to 13.8 mmHg, p < 0.001) and medications by 69% (2.52 to 0.78, p < 0.001). In Standalone eyes, mean IOP reduced by 42% (25.3 mmHg to 14.6 mmHg, p < 0.001) and medications by 75% (2.98 to 0.74, p < 0.001). At final follow-up, 83% of eyes had achieved ≥ 20% IOP reduction, and all but 1 eye (> 99%) had the same or lower IOP versus preoperative; all eyes (100%) maintained or reduced their medication burden versus preoperative. Favorable safety included 0 intraoperative complications and 0 filtration surgeries through 5 years. Long-term indicators of disease stability (visual fields, retinal nerve-fiber layer thickness, and cup:disc ratio) were unchanged over the course of 5-year follow-up. Conclusions iStent inject produced significant and durable 5-year reductions in IOP (nearly 10-mmHg reduction) and medications (nearly 2-medication reduction), with stable disease parameters over time. Combined and Standalone subgroups had similar outcomes.
Collapse
|
13
|
Paletta Guedes RA, Gravina DM, Paletta Guedes VM, Chaoubah A. Standalone Implantation of 2-3 Trabecular Micro-Bypass Stents (iStent inject ± iStent) as an Alternative to Trabeculectomy for Moderate-to-Severe Glaucoma. Ophthalmol Ther 2022; 11:271-292. [PMID: 34825352 PMCID: PMC8770764 DOI: 10.1007/s40123-021-00424-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/01/2021] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION This retrospective consecutive study compared standalone implantation of multiple (2-3) trabecular micro-bypass stents (iStent inject ± iStent) (Multi-Stent group) vs trabeculectomy + mitomycin C (Trab group) in moderate to severe open-angle glaucoma (OAG). METHODS Eligible patients underwent Multi-Stent or Trab surgery from 2018 to 2020 and had at least 3-month follow-up; visual field mean deviation (VF MD) - 6 dB or worse; inadequate prior response to maximum medications ± laser procedures; and had trabeculectomy as their next planned intervention. Primary effectiveness, safety-adjusted treatment success, was defined as ≥ 20% intraocular pressure (IOP) reduction on the same or fewer medications, without clinically significant safety events (severe complications, secondary surgeries, reinterventions). Secondary effectiveness included mean IOP and medications; qualified and complete attainment of target IOP (≤ 21/18/15/12 mmHg and > 6 mmHg); health-economic and quality-of-life (QoL) measures; and 2-vs-3-stent subgroup analysis. RESULTS The baseline groups (n = 70 Multi-Stent/40 Trab) were similar: mean IOP (21.1 mmHg/22.3 mmHg); medications (2.87/3.10 medications); disease stage (30%/35% severe); VF MD (- 10.1 dB/- 10.4 dB); and mean last follow-up (LFU, 13.1 months/15.7 months) (all differences non-significant). Primary effectiveness: treatment success at LFU was 62.9% vs 30.0% in Multi-Stent vs Trab eyes, respectively (p = 0.001). Secondary effectiveness: At LFU in Multi-Stent vs Trab groups, respectively: mean IOP decreased by 31% to 14.2 mmHg (p < 0.001) vs by 43% to 12.5 mmHg (p < 0.001); mean medications decreased by 51% to 1.31 medications (p < 0.001) vs by 84% to 0.43 medications (p < 0.001). Multi-Stent eyes, compared to Trab eyes, had fewer visits ± reinterventions within 3 months (3.6 vs 6.1, p < 0.001); longer time to first reintervention (12.2 months vs 4.5 months, p = 0.01); fewer total reinterventions (0.26 vs 0.75, p = 0.006); and earlier lifting of postoperative restrictions (12.6 vs 32.1 days, p < 0.001). In 2-vs-3-stent analysis, there was a trend toward more 3-stent eyes achieving target IOP than 2-stent eyes. Visual fields remained stable in both Multi-Stent and Trab eyes. CONCLUSION Implanting 2-3 trabecular micro-bypass stents was a viable alternative to trabeculectomy for moderate-to-severe OAG, with clinically appropriate IOP/medication reductions and higher safety-adjusted treatment success vs trabeculectomy.
Collapse
Affiliation(s)
- Ricardo Augusto Paletta Guedes
- Paletta Guedes Eye Institute, Juiz de Fora, Brazil.
- Federal University of Juiz de Fora, 79, Oscar Vidal Street, Juiz de Fora, MG, Brazil.
| | | | | | - Alfredo Chaoubah
- Federal University of Juiz de Fora, 79, Oscar Vidal Street, Juiz de Fora, MG, Brazil
| |
Collapse
|
14
|
Salimi A, Watt H, Harasymowycz P. Long-term outcomes of two first-generation trabecular micro-bypass stents (iStent) with phacoemulsification in primary open-angle glaucoma: eight-year results. EYE AND VISION 2021; 8:43. [PMID: 34782017 PMCID: PMC8594216 DOI: 10.1186/s40662-021-00263-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 10/11/2021] [Indexed: 02/06/2023]
Abstract
Background The short- and medium-term outcomes of iStent have been extensively studied; however, only few studies have investigated its long-term outcomes. Here, we assessed the long-term efficacy and safety of two iStents with concomitant cataract surgery in glaucomatous eyes while also evaluating measures of disease stability using visual field and optical coherence tomography (OCT) of the optic nerve and the macula throughout 8 years of follow-up. Methods This longitudinal, single-center consecutive case series included glaucomatous eyes that underwent implantation of two first-generation trabecular micro-bypass stents (iStent) with concomitant cataract surgery. Eight-year efficacy outcomes included mean intraocular pressure (IOP) and medications, as well as surgical success. Eight-year safety outcomes included best-corrected visual acuity (BCVA), visual field mean deviation (VF-MD), cup-to-disc ratio (CDR), retinal nerve fiber layer (RNFL) thickness, ganglion cell-inner plexiform layer (GC-IPL) thickness, and adverse events. Results A total of 62 eyes with primary open-angle glaucoma (POAG) were included. At 8 years postoperative, IOP reduced by 26% from 19.2 ± 3.9 mmHg preoperatively to 14.2 ± 2.4 mmHg (P < 0.001), 91.1% of eyes achieved IOP ≤ 18 mmHg (vs. 51.6% preoperatively), 69.6% of eyes achieved IOP ≤ 15 mmHg (vs. 14.5% preoperatively), and 25% of eyes achieved IOP ≤ 12 mmHg (vs. 1.6% preoperatively). Medication use decreased by 17.9% from 2.8 ± 1.1 preoperatively to 2.3 ± 1.2 (P = 0.018). Surgical success was 90%, as six eyes underwent subsequent glaucoma surgeries. Safety measures of BCVA, CDR, RNFL thickness and GC-IPL thickness remained stable through 8 years postoperative. VF-MD remained stable until postoperative year 5 and subsequently progressed according to the natural history of glaucomatous disease. Conclusions Implantation of two iStents with concomitant cataract surgery is an effective and safe treatment option for surgery-naïve POAG eyes, evidenced by significant IOP and medication reductions, reasonable surgical success, and favorable safety outcomes, throughout the 8-year follow-up. Our data additionally supports the efficacy of this combined procedure in stabilizing or slowing disease progression. Supplementary Information The online version contains supplementary material available at 10.1186/s40662-021-00263-1.
Collapse
Affiliation(s)
- Ali Salimi
- Department of Ophthalmology, Faculty of Medicine, McGill University, Montreal, QC, Canada.,Montreal Glaucoma Institute, Montreal, QC, Canada
| | - Harrison Watt
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Paul Harasymowycz
- Montreal Glaucoma Institute, Montreal, QC, Canada. .,Department of Ophthalmology, University of Montreal, 4135 de Rouen, Montreal, QC, H1V1G5, Canada.
| |
Collapse
|
15
|
Al Habash A, Otaif W. Surgical Outcomes of Combined 2nd-Generation Trabecular Microbypass (iStent Inject) and Cataract Surgery for the Treatment of Primary Open-Angle Glaucoma in the Saudi Population. Ophthalmol Ther 2021; 10:923-933. [PMID: 34351592 PMCID: PMC8589900 DOI: 10.1007/s40123-021-00380-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/19/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION To investigate the 24-month efficacy and safety of iStent inject trabecular microbypass system implantation combined with phacoemulsification in subjects with primary open-angle glaucoma (POAG) and concomitant cataract. METHODS This prospective, uncontrolled, interventional case series included 36 eyes (29 subjects) with POAG of mild to moderate severity and coexisting cataract that underwent combined phacoemulsification and implantation of a second-generation trabecular microbypass stent (iStent inject®). Main outcome measures involved mean intraocular pressure (IOP), number of antiglaucoma medications, and proportional analysis of eyes with IOP ≤ 18 mmHg or ≤ 15 mmHg, or with 0 or ≥ 2 glaucoma medications. Secondary outcome measures involved the cup-to-disc ratio, corrected distance visual acuity (CDVA), and adverse issues. RESULTS In 36 eyes, the mean IOP at baseline was 18.28 ± 2.87 mmHg, which decreased to 14.24 ± 1.36 (22.1%) and 14.46 ± 1.56 mmHg (20.9%) at 18 and 24 months, respectively (p < 0.001). At the last follow-up, 100% of eyes had an IOP ≤ 18 mmHg (vs. 50% preoperatively), and 75.7% of eyes had an IOP ≤ 15 mmHg (vs. 16.7% preoperatively); 58.3% of eyes achieved ≥ 20% IOP reduction from preoperative status. At baseline, eyes were treated with a mean of 2.35 ± 1.18 medications, which was reduced to 0.80 ± 1.04 (66% reduction) and 0.69 ± 0.95 medications (70.6% reduction) at 18 and 24 months, respectively (p < 0.001). At the last follow-up, 54.1% of eyes were medication-free (vs. 0% preoperatively) and 24.3% of eyes were treated with ≥ 2 medications (vs. 64.9% preoperatively). This combined procedure demonstrated an excellent safety profile with no reported intraoperative complications or adverse events; CDVA was maintained throughout the entire follow-up period. CONCLUSIONS This real-world series demonstrated that iStent inject device implantation at the time of phacoemulsification is a safe and effective method to decrease IOP and the necessity for antiglaucoma medications in patients with mild-to-moderate POAG and cataract; no associated vision-threatening complications were noted.
Collapse
Affiliation(s)
- Ahmed Al Habash
- Department of Ophthalmology, King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
| | - Wael Otaif
- Department of Ophthalmology, King Khalid University, Abha, Saudi Arabia
| |
Collapse
|
16
|
Paletta Guedes RA, Gravina DM, Paletta Guedes VM, Chaoubah A. Two-Year Comparative Outcomes of First- and Second-Generation Trabecular Micro-Bypass Stents with Cataract Surgery. Clin Ophthalmol 2021; 15:1861-1873. [PMID: 33981138 PMCID: PMC8108397 DOI: 10.2147/opth.s302684] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/18/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION This retrospective comparative study assessed real-world effectiveness and safety of first-generation (iStent®) and second-generation (iStent inject®) trabecular micro-bypass stents with cataract surgery in patients with open-angle glaucoma (OAG). MATERIAL AND METHODS Through a 24-month postoperative follow-up, the effectiveness was quantified by intraocular pressure (IOP) reduction; mean glaucoma medication reduction; proportional analysis of eyes meeting IOP cutoffs (<18, <15, <12 mmHg) either with or without medications; and proportional analysis of medication burden. Safety measures included visual acuity, adverse events, and secondary surgery. RESULTS A total of 82 consecutive eyes (39 iStent, 43 iStent inject) with a 24-month follow-up were analyzed. Most eyes (74.4%) had primary open-angle glaucoma, with the remainder having pseudoexfoliative or pigmentary glaucoma; all eyes had mild-to-moderate disease. At 24 months postoperative, the mean IOP was lower, and the percent reduction from baseline was greater, in iStent inject eyes (26.0% reduction, 17.7mmHg to 13.1mmHg) than in iStent eyes (9.8% reduction, 16.4mmHg to 14.8mmHg) (between-groups comparison, p=0.019). Within each group, the postoperative IOP reduction was greater in eyes with higher baseline IOP (p<0.001). Medication burden decreased significantly in both groups, from 1.74 to 0.51 mean medications for iStent (70.7% reduction, p<0.0001), and 2.19 to 0.65 for iStent inject (70.3% reduction, p<0.0001). Both groups exhibited excellent safety. CONCLUSION iStent or iStent inject with phacoemulsification produced significant IOP and medication reductions, with effects enduring for two years. IOP reductions were greater for iStent inject than for iStent. Within each group, higher preoperative IOP was associated with greater postoperative IOP reduction.
Collapse
Affiliation(s)
| | | | | | - Alfredo Chaoubah
- Statistics Department, Federal University of Juiz De Fora, Juiz de Fora, MG, Brazil
| |
Collapse
|