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Ali Salimi, Paul Harasymowycz; Implantation of two second-generation trabecular micro-bypass stents with concomitant cataract surgery in primary angle closure glaucoma: one-year outcome. Invest. Ophthalmol. Vis. Sci. 2019;60(9):5242. doi: https://doi.org/.
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The recent emergence of second-generation trabecular microbypass stents has allowed improved multidirectional flow with good efficacy and safety profile in primary open-angle glaucoma. The efficacy of this new device in primary angle closure glaucoma has been understudied. Thus, we aimed to assess the one-year postoperative outcomes following implantation of two second-generation trabecular micro-bypass stents (iStent inject®) with concomitant cataract surgery in angle-closure glaucoma patients.
In this retrospective chart review study, we evaluated the baseline clinical characteristics and the 12-month outcomes of patients with mild to severe primary angle-closure glaucoma who underwent implantation of two iStent inject devices with concomitant cataract surgery, at a single ophthalmology clinic. The primary outcomes included intraocular pressure (IOP) and anti-glaucoma medication use. The secondary outcomes were success rate (defined by IOP between 5 and 18 mmHg with IOP reduction of at least 20%), visual acuity, and complications. Changes in IOP, medication burden, and visual acuity were evaluated using repeated measure ANOVA with significance set at p<0.05.
30 eyes of 19 patients were included with an average age of 66.1±9.3 years. All eyes had mild to severe angle-closure glaucoma. The preoperative IOP decreased by 16% from 16.57±3.99 mmHg to 14.97±2.50 (p=0.010, Eta-squared=0.206), and the average anti-glaucoma medication use dropped by 46% from 2.83 to 1.53 at one-year follow-up (p<0.001, Eta-squared=0.570). The 12-month success rate was 47% (14 out of 30), visual acuity remained stable (p=0.123), and the post-operative complications only included a case of microhyphema and a case of IOP spike, which were both minor and resolved spontaneously.
The present study provides clinically relevant, real-world data on the utility of iStent inject with cataract surgery in angle-closure glaucoma – a population that has been understudied in the world of trabecular micro-bypass stents. Patients experienced meaningful individual-level reductions in medication burden, while their already-low IOP was reduced further. These improvements were sustained for one-year post-operative, and the safety was favorable.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
The lines represent IOP (blue) and medication burden (red), and the bars show standard error of the mean
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