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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)
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.
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.
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.
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
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