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Dhakshi Muhundhakumar, Meena Arunakirinathan, Alastair Porteous, Gurjeet Jutley, Philip Bloom, Laura Crawley, Sally Ameen, Faisal Ahmed; iStent and ECP combine effectively with cataract surgery in patients with POAG and cataract. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2047.
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© ARVO (1962-2015); The Authors (2016-present)
Phacoemulsification (phaco) plus procedures that include the newer minimally invasive glaucoma surgery (MIGS) type surgical devices such as the iStent are gaining popularity. Endocyclophotocoagulation (ECP) laser has been available for over 10 years and is also performed in combination with cataract surgery. This retrospective study reports observed outcomes in a large ethnically diverse cohort managed in a tertiary unit, looking at patients who had glaucoma and cataracts and had either a combined phaco with iStent, phaco with ECP laser or phaco surgery alone.
The study included adults, over the age of 18 with POAG or Ocular Hypertension. Patients with previous glaucoma surgery were excluded. Over an average follow up of 3 years (2013-2016) data was gathered on outcomes for patients with phaco combined with either iStent or ECP, or phaco alone. n = 50 in each of the three groups. Key outcomes were visual acuity, intraocular pressure (IOP), number of glaucoma medications and complications. One tailed students t-test was used for statistical analysis.
Both the phaco ECP and phaco iStent groups showed a statistically significant reduction in IOP at 3 years post-op (p<0.05.) In the iStent group mean IOP (mmHg) reduced from 17.4 pre-op to 15.0 post-op. In the ECP group IOP reduced from 17.1 pre-op to 13.8 post-op. In contrast the IOP reduction in the phaco only group did not reach statistical significance; from 16.5 pre-op to 15.3 post-op (p=0.1)All groups showed an improvement in average visual acuity post-op.In the iStent group there was a significant reduction (p<0.05) in average number of medications from 2.1 pre-op to 1.35 post-op, compared to no reduction in the other groups. Complication rates were 6.6% in the iStent and control groups, compared to 8.8% in the ECP group which showed a higher incidence of uveitis, which required a more intensive steroid drop regimen.
Our data shows that both iStent and ECP can reduce IOP in combination with phaco, and iStent can reduce reliance on glaucoma drops with a good safety profile. MIGS offer a safe and effective solution for patients with mild to moderate glaucoma and cataract. This dual pathology is going to become increasingly commonplace with an ageing population, and interventions that reduce the need for multiple follow-ups and costly drop treatments are increasingly becoming a necessity in the glaucoma surgeon’s toolkit.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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