Abstract
Purpose :
With the advent of newer IOP-lowering techniques in the form of micro-invasive glaucoma surgeries (MIGS), the glaucoma treatment paradigm has shifted to bridge the gap between medical therapy and invasive incisional glaucoma surgery. The goal of this retrospective study is to determine the effect on IOP and number of glaucoma medications in patients with POAG that have undergone cataract surgery in conjunction with one of 2 angle-based MIGS procedures: Gonioscopy-Assisted Transluminal Trabeculotomy with iTrack catheter (phaco-GATT) or goniotomy (Kahook Dual Blade, phaco-KDB).
Methods :
Retrospective cohort study of patients with POAG undergoing cataract extraction combined with one of 2 MIGS procedures at the University of Chicago between 2019-2022 to assess the mean reduction in the IOP and number of glaucoma medications in patients and possible associated risk factors. Patients who underwent KDB or GATT were either not on aspirin/anticoagulation therapy or were able to hold treatment for a week before surgery. We compared between groups using Chi-square tests for categorical variables and t-test for continuous variables as appropriate.
Results :
A total of 89 eyes from 65 patients were analyzed. The mean age was 79 years while 60% were female and 87% were Black. A subset of 59 (66%) eyes underwent phaco-KDB and 30 (33%) eyes underwent phaco-GATT. The overall reduction in IOP was significantly greater at 25.5% in the GATT group compared to 5.3% in the KDB group. The reduction in topical glaucoma medications was 20% with 12 (21%) of subjects off of all drops in the KDB group and 18% with 4 (13%) of the subjects) off of all drops in the GATT group. Patients with mild to moderate POAG experienced the greatest reduction in IOP and medications in both groups and were more likely to be off of all glaucoma drops.
Conclusions :
In this study, the reduction in IOP and number of glaucoma medications was found to be the greatest in mild-moderate POAG patients across both MIGS groups while the mean IOP reduction was significantly greater in the phaco-GATT group. Patients with severe stage POAG were more likely to undergo phaco-GATT than patients with mild-mod POAG. While IOP reduction can be modest in MIGS, the overall reduction in medication burden can greatly improve compliance. Further studies are needed to evaluate the impact of MIGS on long-term prognosis.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.