Abstract
Purpose :
To evaluate the efficacy and safety of combined cataract extraction (CE) and either excisional goniotomy performed with Kahook Dual Blade (KDB), iStent or iStent inject trabecular bypass implantation in patients with mild to moderate open-angle glaucoma and visually significant cataract.
Methods :
A retrospective analysis was performed on 55 eyes of 51 adults with mild to moderate open-angle glaucoma treated with one or more intraocular pressure (IOP)-lowering medications who underwent combined CE and iStent, iStent inject or KDB. Inclusion criteria included no previous glaucoma surgeries and one year of postoperative follow up. Data included best-corrected visual acuity (BCVA), IOP, IOP lowering medications, and adverse events (AE) collected through 12 months postop. The primary outcome variables were IOP reduction and reduction in number of IOP lowering medications.
Results :
35 iStent eyes, 7 iStent inject eyes and 13 KDB eyes were included in the study. Mean preoperative IOP was 19.15 ± 5.29 mmHg on a mean number of 1.67 medications. At 12 months postoperative, mean IOP decreased 3.70 ± 4.50 mmHg (p < 0.001) in iStent group, 6.64 ± 2.38 mmHg (p < 0.001) in the iStent inject group and 3.59 ± 3.84 mmHg (p = 0.082) in KDB group. Mean number of medications decreased 1.06 ± 0.32 (p < 0.001) in iStent group, 1.25 ± 0.96 (p < 0.001) in the iStent inject group and 0.57 ± 0.60 (p = 0.061) in KDB group. A favorable safety profile included no intraoperative AE, and BCVA of 20/40 or better in 96% of eyes at 12 months.
Conclusions :
iStent and iStent inject with CE led to statistically significant and clinically meaningful reductions in IOP and glaucoma medication burden at 12 months, adding to existing literature that these implants are safe and effective add-on procedures for cataract surgeons to incorporate into practice. KDB did not show statistically significant reductions, which may be due to inherent technique variability. iStent and iStent inject allow anterior segment surgeons to offer, in a single low-risk procedure, increased visual potential by removing the cataract and improved quality of life by decreasing dependence of eye drops, maintaining long term IOP control and slowing the progression of glaucoma. Prospective large-scale studies would help further elucidate the role of these MIGS procedures with CE.
This is a 2021 ARVO Annual Meeting abstract.