Abstract
Purpose :
Phacoemulsification cataract surgery (PCS) is an important surgical treatment for primary angle closure glaucoma (PACG). Since the introduction of iStent, PCS combined with iStent has been advocated in previous studies, however, there is a paucity of comparative data in this area. We conducted a retrospective observational clinical study to evaluate the efficacy, safety and complication rates of PCS only versus combined PCS with iStent in PACG.
Methods :
This retrospective study compared the outcomes of 44 patients who underwent combined PCS and iStent with 45 patients who underwent PCS only. Only patients with a diagnoses of PACG were enrolled. The primary success endpoint was defined as intraocular pressure (IOP)<21 mmHg and ≥20% reduction in IOP at 1 year regardless of the number of glaucoma medications (NGM). Secondary endpoints included IOP, NGM, visual acuity (VA) and complications. All patients had at least 1 year of follow-up.
Results :
The mean age, pre-operative IOP and NGM in the PCS-iStent and PCS-only groups were 71.2 ± 13 years and 65.3 ± 13.2 years (P>0.05), 21.1 ± 9.3 mmHg and 17.8 ± 7.1 mmHg (P>0.05), and 3.2 ± 1.2 and 2.2 ± 1.7(P<0.01), respectively. In both groups, there was a significant increase in VA and reduction in the IOP and NGM observed post-surgery (P<0.05). At one year, there was no significant difference in IOP and NGM reduction between both groups (P=0.48, P=0.17), 22.3% (5.7 ± 6.4 mmHg) reduction in IOP and 1.7 ± 1.5 reduction in NGM in the PCS-iStent group compared to 20.7% (5 ± 6.9 mmHg) reduction in IOP and 1.3± 1.7 reduction in NGM in the PCS-only group. Four patients (9%) in the PCS-iStent group required further glaucoma surgery to reduce the IOP compared to none in the PCS-only group. At 1 year, 50% in the PCS-iStent group met the success criteria compared to 51.3% in the PCS-only group.
Conclusions :
iStent provides no additional IOP reduction when combined with cataract surgery in PACG. There was no increase in complication rate and no significant difference in NGM reduction. Therefore, there is no additional benefits in the use of iStent at the time of PCS for patients with PACG.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.