June 2020
Volume 61, Issue 7
Free
ARVO Annual Meeting Abstract  |   June 2020
1-year Outcome of Combined Phacoemulsification and Insertion of an Ab Interno Implanted Trabecular Micro-Bypass in Patients with Ocular Hypertension or Glaucoma: Efficacy, Complications and Visual Outcomes
Author Affiliations & Notes
  • George Agorogiannis
    Glaucoma, Moorfields Eye Hospital NHS Trust, London, United Kingdom
  • Stelios Georgoulas
    Ophthalmology/Glaucoma, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, United Kingdom
    Glaucoma, Moorfields Eye Hospital NHS Trust, London, United Kingdom
  • Anthimos Vlavianos
    Ophthalmology/Glaucoma, East Suffolk and North Essex NHS Foundation Trust, Ipswich, East Suffolk, United Kingdom
    Glaucoma, Moorfields Eye Hospital NHS Trust, London, United Kingdom
  • Jonathan Clarke
    Glaucoma, Moorfields Eye Hospital NHS Trust, London, United Kingdom
    Moorfields Eye Hospital and UCL Institute of Ophthalmology, NIHR Biomedical Research Centre for Ophthalmology, London, United Kingdom
  • Footnotes
    Commercial Relationships   George Agorogiannis, None; Stelios Georgoulas, None; Anthimos Vlavianos, None; Jonathan Clarke, Allergan (R), Aspire Pharmaceutical (C), Glaukos (R), Santen (C)
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science June 2020, Vol.61, 3154. doi:
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      George Agorogiannis, Stelios Georgoulas, Anthimos Vlavianos, Jonathan Clarke; 1-year Outcome of Combined Phacoemulsification and Insertion of an Ab Interno Implanted Trabecular Micro-Bypass in Patients with Ocular Hypertension or Glaucoma: Efficacy, Complications and Visual Outcomes. Invest. Ophthalmol. Vis. Sci. 2020;61(7):3154.

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

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Abstract

Purpose : This retrospective study assessed the 12-month safety and effectiveness of iStent® or iStent inject® trabecular micro-bypass implant with cataract surgery in patients with ocular hypertension (OHT) or glaucoma.

Methods : Parameters analysed were age at date of surgery, gender, ethnic origin, previous treatments, condition treated, implant type, visual acuity, intraocular pressure (IOP) and number of glaucoma agents at time points pre-op, 1 week, 4-6 weeks, 3, 6 and 12 months post op, Humphrey Mean Deviation (MD) at time points pre-op and 12 months post-op.

Results : 70 patients and 82 eyes were operated for phacoemulsification with iStent® or iStent inject® from Apr 2017 to Aug 2018. 58 patients underwent 1 eye surgery and 12 in both. Sample was predominantly female (55 eyes), Caucasian (24 eyes) with mean age 75.27±6.46years. 71 eyes had no previous glaucoma operation, 6 iridotomies, 3 selective laser trabeculoplasty, and 2 trabeculectomies. Condition treated was mainly POAG (43 eyes) or OHT (17 eyes). 43 eyes were implanted with the iStent®, 36 with iStent inject® and in 3 type of stent wasn't recorded. 73 eyes didn't have any intraoperative complication and 5 had significant hyphema obscuring the view (resulting in abandoning insertion in 1 case). In 1 eye an iris cleft was caused. In 2 eyes the insertion was abandoned without hyphema. In 1 case the second implant did not release.
MD (24-2 SITA Fast) of eyes treated with cataract iStent/iStent inject® improved during the studied period (-6.67±5.72dB pre-op to -5.83±6.00dB 12 months post-op, p=0.047).
IOP was found reduced in all time points; mean IOP pre-op was 17.49mmHg reduced to 15.27 at 1 week (p=.000), 15.41 at 4-6 weeks (p=.002), 13.88 at 3 months (p=.000), 14.62 at 6 months (p=0.000) and 14.78 at 12 months (p=.000).
Glaucoma agents were reduced at all time points; mean number of medication used was 1.89 pre-operatively, 1.48 at time point 1 week post-operatively (p=.002), 1.18 at week 4-6 (p=.001), 1.24 at 3 months (p=.083), 1.60 at 6 months (p=.080) and 1.51 at 12 months (p=.016). 2 patients needed trabeculectomy.

Conclusions : In our cohort study combined phacoemulsification with iStent® or iStent inject® implantation achieved reduction of IOP and glaucoma medications with improvement of visual function quality with safe profile.

This is a 2020 ARVO Annual Meeting abstract.

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