Name

566 - Résultats à un an de la chirurgie de la cataracte combinée à l'implantation de deux micro-stents de pontage trabéculaire de deuxième génération (iStent inject)

The first generation of trabecular micro-bypass stents has been effective in reducing the intraocular pressure (IOP) and medication burden in patients with open angle glaucoma and cataract. The recent emergence of second generation of trabecular microbypass stents has allowed improved multidirectional flow with good efficacy and safety profile. We have assessed the outcomes following implantation of two second-generation trabecular micro-bypass stents (iStent inject) with concomitant cataract surgery in glaucoma patients with varying glaucoma severity from mild to severe.

In this retrospective chart review study, we evaluated the baseline clinical characteristics and the 12-month outcomes of patients with mild to severe glaucoma who underwent implantation of two iStent inject devices with concomitant cataract surgery, at a single ophthalmology clinic. The primary outcomes included the intraocular pressure (IOP) and anti-glaucoma medication use. The secondary outcomes were complete success rate (IOP≤18 mmHg without any anti-glaucoma medications) and qualified success rate (IOP≤18 mmHg with or without anti-glaucoma medications). Changes in IOP and medications were evaluated using repeated measure ANOVA with significance set at p<0.05.

A total of 101 eyes of 61 patients were included with an average age of 68.5±8.8 years. All eyes had moderate to severe glaucoma with the following subtypes: 56% primary open-angle, 18% primary closed-angle, 13% normal tension, 7% pseudoexfoliation, 5% pigmentary, and 1% congenital glaucoma. The preoperative IOP decreased significantly from 16.6±4.0 mmHg to 14.3±2.8 (p<0.001), and the average anti-glaucoma medication use dropped by 53% at one-year follow-up (p<0.001). Qualified and complete success rates were 90.1% and 38.6%, respectively. There were no intraoperative complications; however, eight eyes underwent secondary surgery for management of elevated IOP.

The present study provides clinically relevant, real-world data on the utility of iStent inject with cataract surgery in a heterogeneous, adequately sized patient population.  Patients experienced meaningful individual-level reductions in medication burden, while participants’ already-low IOP was reduced further.  IOP and medication reductions were sustained consistently through 12 months postoperative, and safety was favorable.

The findings of this retrospective case series from a Canadian ophthalmology clinic suggests that implantation of second-generation trabecular micro-bypass stents (iStent inject) combined with phacoemulsification is an effective treatment modality in reducing the IOP and the medication burden with a high success rate and a favorable safety profile in mild to severe glaucoma patients.