Abstract
Purpose :
To explore the comparative safety and efficacy of evolving MIGS procedures/devices, the Hydrus, Kahook, and iStent in the Philadelphia VA population to guide future decision-making about the most suitable glaucoma treatment in a resident-training population with diverse demographics.
Methods :
A retrospective chart review was conducted for patients who underwent a Minimally Invasive Glaucoma Surgery (MIGS) operation in conjunction with cataract surgery at the Philadelphia Veterans Administration Medical center from approximately 01/01/2015 – 11/1/2020. Descriptive analyses, ANOVA and chi-squared analyses were performed to compare across MIGS types.
Results :
126 patients undergoing MIGS procedure were included. 96% were male, 69.84% African-American, and 29.36% Caucasian. 46.03% patients received a Hydrus, 31.75% an iStent, and 22.22% a Kahook. The average preoperative maximum intraocular pressure was 23.78 mmHg, with an average preoperative IOP of 15.78 mmHg and an average preoperative drop number (total number of glaucoma medications used per day) of 1.45, not significantly different across MIGS types. When separated out by MIGS used, Hydrus demonstrated the greatest reduction in IOP, on average a reduction of 6.14 mmHg at initial post-operative visit and 4.08 mmHg at final post-operative visit, a statistically significant decrease in intraocular pressure when compared to both the iStent and the Kahook (p < .05) at postoperative day 1 and postoperative week 1. However, at the 9-12 months postoperative visit the Hydrus was only statistically significantly better at reducing IOP compared to the iStent, and performed similarly to the Kahook. The Hydrus demonstrated a statistically significant decrease in medication reduction (either frequency or number) when compared to both the Kahook and iStent (p< .05). There were no significant differences in complication rates across MIGS types.
Conclusions :
Overall, this study suggests that Hydrus may be more efficacious than the iStent and the Kahook initially in decreasing glaucoma medication use and IOP postoperatively, however, this difference may not be statistically significant in longer term follow up. More studies are needed to evaluate outcomes in glaucoma populations of different severities.
This is a 2021 ARVO Annual Meeting abstract.