September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Micro-invasive Glaucoma Stent (MIGS) Surgery using the Ivantis HydrusTM Microstent: outcomes and the learning curve.
Author Affiliations & Notes
  • Toby Al-Mugheiry
    Ophthalmology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
  • Heidi Cate
    Ophthalmology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
    University of East Anglia, Norwich, United Kingdom
  • Allan Clark
    University of East Anglia, Norwich, United Kingdom
  • David C Broadway
    Ophthalmology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
    University of East Anglia, Norwich, United Kingdom
  • Footnotes
    Commercial Relationships   Toby Al-Mugheiry, None; Heidi Cate, None; Allan Clark, None; David Broadway, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 6506. doi:
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      Toby Al-Mugheiry, Heidi Cate, Allan Clark, David C Broadway; Micro-invasive Glaucoma Stent (MIGS) Surgery using the Ivantis HydrusTM Microstent: outcomes and the learning curve.. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6506.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To evaluate the ocular hypotensive effects of a micro-invasive glaucoma stent, inserted at the time of routine cataract surgery, in a series of glaucoma patients and assess the learning curve for the procedure.

Methods : Single centre, observational cohort study of the first 20 consecutive Ivantis HydrusTM MIGS insertions with concurrent cataract surgery, in patients with glaucoma for a single surgeon. The cases were followed for a mean of more than 9 months. Success survival was defined with respect to various intraocular pressure (IOP) targets (21, 18 and 15mmHg) and the reduction in required topical anti-glaucoma medications. Complete success was defined as achieving target IOP without the need for anti-glaucomatous therapy. To take account of the IOP lowering effect of pre-operative anti-glaucomatous therapy, a separate analysis using simulated untreated IOP (+2mmHg for each medication) was performed. In addition, a learning curve analysis was performed.

Results : The mean follow-up period for the entire cohort was 9.3(±4.8; range 3-24) months. At final follow-up the mean IOP for all eyes was reduced from a treated pre-operative value of 17.3(±2.5)mmHg [and a simulated untreated value of 21.3(±2.6)mmHg] to 15.0(±1.8)mmHg (p<0.002; p<0.0001 respectively) and the mean number of topical anti-glaucoma medications was reduced from 2.0(±0.98) to no medications (p<0.0001). Complete success (IOP<21mmHg, no medications) was 100% at final follow-up. Complete success (IOP<18mmHg, no medications) was 87% at final follow-up. Complete success (IOP<15mmHg, no medications) was 43% at final follow-up. Kaplan-Meier survival curves are shown in the Figure. No clinically significant adverse effects were identified and there were minimal learning effects with respect to IOP outcomes.

Conclusions : Adjunctive MIGS surgery with concurrent cataract surgery was highly successful in lowering IOP and abolishing the requirement for anti-glaucoma medication. The ocular hypotensive effect was maintained at a year post-op. For a trained cataract and glaucoma surgeon no significant learning curve effects were identified.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

 

Figure: Kaplan-Meier survival curves for three different target IOPs

Figure: Kaplan-Meier survival curves for three different target IOPs

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