Abstract
Purpose :
Understanding the relative efficacy of different microinvasive glaucoma procedures (MIGS) is integral to clinical decision making. For the first time, this study compares outcomes of phacoemulsification combined with Hydrus Microstent (Phaco/Hydrus; Ivantis Inc., CA) or Kahook Dual Blade (Phaco/KDB; New World Medical, CA).
Methods :
This retrospective study included patients who underwent Phaco/Hydrus or Phaco/KDB from January 2016 to 2021 at Massachusetts Eye and Ear. Baseline characteristics comprised demographic variables, corrected distance visual acuity, intraocular pressure (IOP), medication burden, glaucoma type, severity, and history of prior laser or surgery. Primary outcomes were IOP and medication burden evaluated by Generalized Estimating Equations (GEE). Two Kaplan-Meier Estimates (KM) assessed survival without additional glaucoma procedure or medication while maintaining: (1) IOP ≤21 mmHg and ≥20% IOP reduction or (2) IOP ≤ preoperatively designated goal.
Results :
Mean preoperative IOP was 17.70 mmHg ± 4.91 (SD) on 0.28 ± 0.86 medications in the Phaco/Hydrus group (N=69) and 15.92 ± 4.34 mmHg on 0.19 ± 0.70 medications in the Phaco/KDB group (N=62). The Phaco/Hydrus group was more likely at baseline to have elevated IOP (p=0.02). All other baseline characteristics were statistically similar between surgeries. At 12 months, mean IOP was reduced to 14.98 ± 2.77 mmHg on 0.12 ± 0.60 medications after Phaco/Hydrus and 13.52 ± 4.13 mmHg on 0.04 ± 0.19 medications after Phaco/KDB. GEE models of IOP (p<0.001) and medication burden (p=0.04) had significant patterns of reduction across all timepoints, after adjusting for baseline IOP. There was no difference in the pattern of change in IOP (p=0.83) or medication burden (p=0.84) when evaluated over time between procedures, after adjusting for baseline IOP. Phaco/Hydrus and Phaco/KDB were not different in survival by KM1 (p=0.72) or KM2 (p=0.11).
Conclusions :
Both Phaco/Hydrus and Phaco/KDB resulted in significantly reduced IOP and medication burden for more than 12 months. Reductions were not significantly different between surgeries. This study compared Phaco/Hydrus and Phaco/KDB for the first time to assert that the surgeries confer similar outcomes in IOP, medication burden, and survival estimates in a population with predominantly mild and moderate glaucoma.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.