Abstract
Purpose :
The use of minimally invasive glaucoma surgery (MIGS) during cataract surgery for patients with glaucoma has increased, accelerated by shorter surgical times and potentially less complications compared to glaucoma drainage device (GDD) implantation or trabeculectomy. Additionally, MIGS may help decrease eye drop burden, which is limited by patient adherence and can cause ocular surface toxicity. While several studies have evaluated clinical parameters following MIGS, information about longer term visual field (VF) outcomes is not widely available. The goal of this study is to evaluate long term clinical and VF outcomes following MIGS combined with cataract surgery.
Methods :
This is a retrospective single-center case series of patients with glaucoma who had MIGS during cataract surgery between 11/2015 and 10/2019. Inclusion criteria were at least a 1-year of post-operative follow up, no history of prior incisional surgery, a reliable pre-operative VF, and a reliable post-operative VF at least 1 year after surgery. Clinical and VF metrics were assessed pre-operatively and at 1, 2, and 3 years post-operatively. Data collected included visual acuity (VA), intraocular pressure (IOP), number of glaucoma medications, VF mean deviation (MD), pattern standard deviation (PSD), and visual field index (VFI).
Results :
73 eyes of 60 patients were included, 50% male. The most common glaucoma diagnosis was primary open angle glaucoma (81%). MIGS devices included iStent, Trabectome, and Cypass Micro-Stent. Mean±SD IOP before surgery was 16.8±3.6 mmHg on 2.4±1.3 medications. At 3-year follow up (n=34 eyes), mean IOP was 16.4±2.9 mmHg (P=0.07) on 1.5± 1.4 glaucoma medications (P<0.001). Baseline VF metrics included MD of -6.2±5.9 dB, PSD of 5.3±4.0 dB, and VFI of 84±19%. There were no significant changes in MD, PSD, or VFI over time compared to baseline. VA improved from LogMAR 0.19±0.14 pre-operatively to 0.08±0.15 post-operatively (P<0.001).
Conclusions :
Over the 3 year post-operative period of our cohort, MIGS combined with cataract surgery was associated with stable VF metrics as well as stable IOP with significant reduction in the number of glaucoma medications.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.