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

Abstract

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.