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Mia Miller, Bret Hughes, Joshua Apple, Chaesik Kim, Justin Tannir, Anju Goyal, Aman Shukairy, Chaesik Kim; Comparison of Outcomes of iStent with Cataract Surgery versus Cataract Surgery Alone in Open-Angle Glaucoma. Invest. Ophthalmol. Vis. Sci. 2014;55(13):6126.
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To evaluate the changes in intraocular pressure (IOP) and medication use with placement of the iStent in combination with cataract surgery versus cataract surgery alone in patients with primary open-angle glaucoma.
A retrospective chart review of 132 eyes diagnosed with cataract and primary open-angle glaucoma who underwent cataract surgery combined with Glaukos iStent implant versus cataract surgery alone. Intraocular pressures were measured through 6 months following surgery. Success was defined as post-surgery IOP <21mmHg on 1 or less medications with no additional surgeries. Statistical analysis was performed using unpaired t-test, chi square and Kaplan Meier survival analysis.
The 132 eyes were comprised of two groups. Group 1 included 31 patients with moderate glaucoma who underwent cataract surgery with iStent placement. Group 2 included 101 patients with moderate glaucoma who underwent cataract surgery alone. The demographics of both groups were similar in age, gender, race, hypertension and diabetes prevalence and number of pre-op medications (p > 0.05). The mean pre-op IOP were 18.1 mmHg and 15.4 in Group 1 and Group 2, respectively (p = 0.0013). Using Kaplan Meier Survival Analysis we found a 76% success rate in Group 1 versus a 54% in Group 2 at six months (p = 0.42). Moreover, there was a significant reduction in the number of medications needed in both groups. Group 1 had a significantly greater reduction in post-operative medical dependency compared with Group 2, 0.37 and 1.4 medications, respectively at six months (p = 0.0039).
Our study shows that iStent implantation at the time of cataract extraction may be of benefit in patients with primary open-angle glaucoma. Although not statistically significant, there was greater success with IOP control in Group 1 compared to Group 2 by our criteria, as well as a statistically significant reduction in number of medications needed in Group 1 versus Group 2.
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