Comparing outcomes of phacoemulsification and two trabecular stents (iStent inject®) with (π³) or without (π²) trabecular trephine (iAccess®).

Abstract

Purpose : To study the additive effect of trabecular trephine (iAccess®) to phacoemulsification with two trabecular stents (iStent inject®) in glaucoma patients.

Methods : A total of 270 visits from 42 patients were reviewed following phacoemulsification with two trabecular stents with (Phaco/iStent inject/iAccess, π³) or without trabecular trephine (Phaco/iStent inject, π²) from 2021-2023. Two Kaplan-Meier curves (KM) assessed survival (1) without meds [CS – complete success] or (2) with ≤ baseline meds [QS – qualified success], while maintaining IOP reduction ≥ 20% with 5 mmHg ≤ IOP ≤ 18 mmHg for at least two consecutive visits. Welch's t-tests were used to compare IOP and medication reduction between groups at significant timepoints over a 8-month follow-up period. Retrospective, comparative study from a tertiary care center.

Results : Twenty-five patients had π³ and 17 underwent π². The most common glaucoma type in both groups was primary open-angle glaucoma (52% in π³ vs. 37% in π²; p=0.45). Both groups had similar baseline demographics except for ethnicity with significantly more Hispanic patients in the π³ group (48% vs 6%, p=0.007). Mean preoperative IOP was 13.24 ± 3.22 mmHg on 1.72 ± 1.21 medications in π³ and 12.94 ± 3.85 mmHg on 1.35 ± 1.17 medications in π² (p=0.71 for IOP; p=0.31 for medications). Under CS criteria, the success rate was similar between groupsat POM6 (75% vs 59%; p=0.87) and significantly higher in π³ at POM8 (75% vs 20%; p=0.039). Under QS criteria, the success rate was similar at both POM6 (78% in π³ vs. 82% in π²; p=0.87) and POM8 (78% in π³ vs. 73% in π²; p=0.61). Mean IOP at POM8 was reduced to 11.24 ± 3.62 mmHg on 0.18 medications after π³ and 10.85 ± 3.38 mmHg on 0.30 medications after π² (p=0.82 for IOP; p=0.78 for medications).

Conclusions : π³ appears to confer at least similar IOP reduction, medication reduction, and QS rates to π², but it may provide more favorable CS rates at 8 months.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.

 

Survival comparison for π³ vs π² under CS criteria: no medications, IOP reduction ≥ 20%, and 5 mmHg ≤ IOP ≤ 18 mmHg

 

Survival comparison for π³ vs π² under QS criteria: ≤ baseline meds, IOP reduction ≥ 20%, and 5 mmHg ≤ IOP ≤ 18 mmHg