July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Comparison of 1 year effectiveness of trabecular microbypass stent implantation (iStent) among mild, moderate, and severe primary open angle glaucoma
Author Affiliations & Notes
  • Sunee Chansangpetch
    UCSF, San Francisco, California, United States
    Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thailand
  • Mantapond Ittarat
    Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thailand
    Stanford University, California, United States
  • Shuo Yang
    Beijing Chao Yang Hospital, Capital Medical University, China
    Stanford University, California, United States
  • Ann C Fisher
    Stanford University, California, United States
  • Kuldev Singh
    Stanford University, California, United States
  • Shan C Lin
    UCSF, San Francisco, California, United States
    Glaucoma Center of San Francisco, California, United States
  • Robert Chang
    Stanford University, California, United States
  • Footnotes
    Commercial Relationships   Sunee Chansangpetch, None; Mantapond Ittarat, None; Shuo Yang, None; Ann Fisher, None; Kuldev Singh, None; Shan Lin, None; Robert Chang, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 6622. doi:https://doi.org/
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      Sunee Chansangpetch, Mantapond Ittarat, Shuo Yang, Ann C Fisher, Kuldev Singh, Shan C Lin, Robert Chang; Comparison of 1 year effectiveness of trabecular microbypass stent implantation (iStent) among mild, moderate, and severe primary open angle glaucoma. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6622. doi: https://doi.org/.

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

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Abstract

Purpose : To evaluate the effectiveness of trabecular microbypass stent implantation (iStent) in combination with cataract surgery in moderate to severe glaucoma compared to mild glaucoma

Methods : Medical charts of primary open angle glaucoma (POAG) subjects undergoing phacoemulsification with single iStent (Glaukos corporation, Laguna Hills, CA) implantation from January 2013 to July 2017 at two sites were retrospectively reviewed. Eyes were classified based on mean deviation (MD) of the preoperative standard automated perimetry into mild (MD >-6 dB), moderate (MD -6 to -12 dB), and severe (MD <-12 dB). Mixed effect regression models were performed to determine the effect of iStent on IOP lowering at 1 year. The outcome measures included (1) IOP and number of medications, (2) eyes with IOP≤18 off medication, and (3) eyes with IOP≤15 off medication.

Results : 104 eyes from 89 subjects were analyzed. Number of eyes (subjects) was 32 (25), 39 (35), and 33 (29) for mild, moderate, and severe glaucoma, respectively. At 1 year, cataract combined with iStent surgery significantly lowered the number of medications in all groups and significantly decreased IOP in moderate and severe glaucoma (p<0.05). Average preoperative IOP ranged between 14-17 mmHg. Success with IOP≤18 mmHg was achieved in 71.8%, 23.1%, and 6.1% of eyes in mild, moderate, and severe, respectively. Percentage of eyes achieving IOP≤15 mmHg was 56.3%, 18.0%, and 3.0% for mild, moderate, and severe glaucoma, respectively. (Figure 1) Mixed effect model with adjustment for age, gender, and baseline number of medications found significantly higher number of medications in moderate (ß 0.58 p=0.002) and severe (ß 1.20 p<0.001) compared to mild glaucoma. Eyes with moderate and severe glaucoma had significantly lower rate of success with IOP≤18 (moderate vs mild OR 0.014, p=0.028; severe vs mild OR 0.001, p=0.017). Eyes with severe glaucoma also had significantly lower rate of success with IOP ≤15 mmHg compared to mild glaucoma (OR 0.003, p=0.04).

Conclusions : Combined cataract surgery with iStent decreases IOP and number of medications in moderate and severe glaucoma at 1 year. However, the effect in these groups was less compared to mild glaucoma.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

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