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Oi Man Mandy Wong, Christopher Kai-Shun Leung; Safety and efficacy of suprachoroidal stent implantation in patients with primary angle closure/primary angle closure glaucoma. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4984.
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While minimally invasive glaucoma surgery has been widely adopted as a treatment option for primary open-angle glaucoma, its role in primary angle-closure(PAC) and primary angle-closure glaucoma(PACG) remains unclear. We performed a prospective interventional case series to investigate the efficacy and safety of a suprachoroidal stent in patients with PAC/PACG.
Eleven eyes of 11 phakic PAC/PACG patients (mean age: 69.2 years, female: n=9) with prior laser iridotomy had a single suprachoroidal stent (iStent Supra, Glaukos) implantation at the superonasal supraciliary/suprachoroidal space. The intraocular pressure(IOP) and number of IOP-lowering medications were measured before, and then 1 day, 1 week, 1 month and 3 months after operation. The supraciliary/suprachoroidal space was imaged with anterior segment optical coherence tomography (AS-OCT) before, and at 1 day and 3 months after the operation.
At baseline visit, the LogMAR visual acuity and visual field mean deviation(MD) were 0.20+/-0.29 and -9.22+/-8.46 dB, respectively. The IOP was 23.0+/-4.4mmHg and the number of glaucoma medication was 2.8+/-1.5. The IOP decreased to 15.3+/-10.6mmHg (p=0.016), 15.5+/-7.0mmHg (p=0.003), 20.5+/-7.6mmHg (p=0.346), 18.6+/-4.0mmHg (p=0.006) at 1 day, 1 week, 1 month and 3months, respectively, and the number of medication decreased to 2.1+/-1.5 (p=0.01) at 3 months post-operatively. There was no intraoperative complication. One patient developed a small hyphema on day 1. One patient had an IOP spike (41 mmHg) at 1 month because of discontinuation of glaucoma medication. Both conditions resolved within a week with topical medications. 80.0% of eyes showed expansion of the supraciliary/suprachoroidal space at day 1 and all resolved at 3 months after the operation (Fig.1).
Implantation of a suprachoroidal stent appears to be a safe and effective procedure in reducing the IOP and the number of glaucoma medications in PAC/PACG patients.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
AS-OCT images (horizontal scan) illustrating expansion of suprachoroidal space (indicated by arrow) at day 1 which resolved at 3 months after the operation.
iStent supra in the supraciliary/suprachoroidal space.
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