July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
Evaluation of a second-generation trabecular micro-bypass stents in patients with primary open angle glaucoma: A retrospective consecutive case series review at a tertiary centre.
Author Affiliations & Notes
  • Mohsin Patel
    Ophthalmology, Kings College, London, United Kingdom
  • Yasmin Vaid
    Ophthalmology, Kings College, London, United Kingdom
  • Miles Parnell
    Ophthalmology, Kings College, London, United Kingdom
  • Julian Robins
    Ophthalmology, Kings College, London, United Kingdom
  • avinash kulkarni
    Ophthalmology, Kings College, London, United Kingdom
  • Sameer Trikha
    Ophthalmology, Kings College, London, United Kingdom
  • Footnotes
    Commercial Relationships   Mohsin Patel, None; Yasmin Vaid, None; Miles Parnell, None; Julian Robins, None; avinash kulkarni, None; Sameer Trikha, None
  • Footnotes
    Support  none
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 6627. doi:
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      Mohsin Patel, Yasmin Vaid, Miles Parnell, Julian Robins, avinash kulkarni, Sameer Trikha; Evaluation of a second-generation trabecular micro-bypass stents in patients with primary open angle glaucoma: A retrospective consecutive case series review at a tertiary centre.. Invest. Ophthalmol. Vis. Sci. 2019;60(9):6627.

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

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Abstract

Purpose :
To evaluate early efficacy and safety data of a second-generation trabecular micro-bypass stent (iStent inject®) in primary open angle glaucoma patients treated at King’s College Hospital NHS Foundation Trust, London, United Kingdom.

Methods :
The study evaluated the preoperative and postoperative Intraocular pressure (IOP), visual acuity and number of medications of patients receiving the istent inject, either as a standalone procedure or combined with phacoemulsification surgery, at a tertiary glaucoma centre. Minimum follow up was determined to be 6 months (range 6-14 months).

Results :
64 istent inject were implanted (71.9% combined with phacoemulsification) with postoperative follow up of at least 6 months. Non-Caucasians represented 53% of our cohort of which majority (71%) were represented by black African/Caribbean.
Mean preoperative IOP was 20.2mmHg (SD 4.86) on an average of 3 medications. There was an average IOP reduction of 4.4mmHg (SD 3.72) over a minimum of 6 months – a 22% reduction (p<0.0001). Patients undergoing combined procedure had a 21% IOP reduction at 6 month compared to those having standalone stent procedure who were found to have a 20% reduction in IOP for the same period. The mean number of medications for both groups reduced to 2 post-operatively.

A reduction in hypotensive medications of 30% was found in those taking 3 or more medications pre-operatively. 59% of patients at 6 months were on reduced IOP Treatment, the mean age was 72 (Range 38-93). Importantly, 82% (14/17) of subjects taking oral acetazolamide pre-operatively no longer required it at 6 months. Five patients required further IOP lowering surgery for uncontrolled IOP in advanced Glaucoma despite iStent implantation. There were no intraoperative complications and no sight-threatening postoperative complications.

Conclusions :
Within a complex, tertiary referral setting istent inject insertion demonstrated a significant reduction in IOP and medication usage, both as a standalone procedure and when combined with phacoemulsification. The overall safety profile was excellent. Furthermore, our data suggests that istent inject can be effective in advanced glaucoma and in patients with uncontrolled IOP on maximal medical treatment.

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

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