Outcomes after combined phacoemulsification and trabecular microbypass stent implantation in controlled open-angle glaucoma

• Published in: Journal of cataract and refractive surgery Vol. 42; no. 9; pp. 1332 - 1338
• Main Authors: Seibold, Leonard K., MD, Gamett, Kevin M., MD, Kennedy, Jeffrey B., MD, Mulvahill, Matthew J., MS, Kroehl, Miranda E., PhD, SooHoo, Jeffrey R., MD, Pantcheva, Mina B., MD, Kahook, Malik Y., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2016
• Subjects: Cataract; Glaucoma, Open-Angle - surgery; Humans; Intraocular Pressure; Lens Implantation, Intraocular; Ophthalmology; Phacoemulsification; Prospective Studies; Retrospective Studies; Stents
• ISSN: 0886-3350; 1873-4502
• DOI: 10.1016/j.jcrs.2016.07.023

Purpose To study the effect of combined phacoemulsification cataract surgery and iStent (trabecular microbypass stent) implantation on intraocular pressure (IOP) and medication use in open-angle glaucoma (OAG) patients with a low mean preoperative IOP. Setting University of Colorado Health Eye Center, Aurora, Colorado, USA. Design Retrospective case series. Methods Treatment outcomes analyzed included IOP, medication use, and corrected distance visual acuity (CDVA). Treatment success was defined as a 20% or more IOP reduction or discontinuation of at least 1 medication. Results Sixty-four eyes of 45 patients were included in the analysis. At 1 year, the mean IOP was significantly reduced from 14.7 ± 3.2 mm Hg (SD) to 13.2 ± 2.8 mm Hg ( P  < .01) and the mean medication use decreased from 1.81 ± 1.13 to 1.41 ± 1.48 ( P  = .0001). The estimated IOP reduction at 1, 3, 6, and 12 months was 3.5% ( P  = .23), 7.9% ( P  = .04), 9.7% ( P  = .01), and 12.2% ( P  = .002), respectively. Treatment success at 1 year was achieved in 76.1% of patients, and 41% of patients were medication free at 1 year. The CDVA was significantly improved from 0.4 ± 0.38 logMAR at baseline to 0.17 ± 0.35 at 1 year ( P  < .0001). Conclusions Combined cataract surgery and trabecular microbypass stent implantation was statistically effective in reducing IOP and/or medication burden in OAG patients with a low preoperative IOP. During the informed surgical consent process, the physician and patient should consider the clinical benefit of modest IOP lowering and/or a decrease in medication use. Financial Disclosure Drs. Seibold, SooHoo, Pantcheva, and Kahook have received grant support from Glaukos Corp. No other author has a financial or proprietary interest in any material or method mentioned.