Clinical Ophthalmology (Jul 2020)

iStent Trabecular Microbypass Stent Implantation with Phacoemulsification in Patients with Open-Angle Glaucoma: 6-Year Outcomes

  • Ferguson TJ,
  • Mechels KB,
  • Dockter Z,
  • Bleeker A,
  • Ibach M,
  • Schweitzer J,
  • Berdahl JP

Journal volume & issue
Vol. Volume 14
pp. 1859 – 1866

Abstract

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Tanner J Ferguson,1 Keegan B Mechels,1 Zachary Dockter,2 Adam Bleeker,2 Mitch Ibach,3 Justin Schweitzer,3 John P Berdahl3 1Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA; 2University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA; 3Vance Thompson Vision, Sioux Falls, SD, USACorrespondence: Tanner J Ferguson Email [email protected]: To investigate the long-term safety and efficacy of an iStent trabecular microbypass stent in combination with cataract surgery in eyes with primary open-angle glaucoma (POAG).Setting: Private practice; Sioux Falls, South Dakota.Design: Retrospective, consecutive case series.Methods: This case series included eyes implanted with a single trabecular microbypass stent in combination with phacoemulsification in patients with mild to severe POAG. Data were collected preoperatively and at day 1, week 1, month 1, and up to 6 years postoperatively. Primary outcome measures included mean intraocular pressure (IOP) and number of glaucoma medications. Safety was noted by assessing the incidence of IOP spikes and need for additional surgery.Results: The study comprised 411 eyes. Mean IOP was reduced to 14.9± 4.2 mmHg compared to 18.8± 5.6 mmHg at baseline at 6 years postoperative. The mean number of medications was reduced to 1.2± 1.0 from 1.4± 1.1 at baseline. In eyes with severe stage of disease, there was a mean IOP reduction > 6 mmHg at 6 years postoperative. Eyes with baseline IOP ≥ 18 mmHg achieved a more robust reduction in IOP. Fifteen eyes underwent a secondary glaucoma procedure. There were no intra- or postoperative complications.Conclusion: Trabecular microbypass stent implantation in combination with cataract surgery provides a sustained IOP reduction in eyes with mild-to-severe POAG. The degree of IOP reduction was more significant in eyes with higher baseline IOP and severe stage of disease.Keywords: microinvasive glaucoma surgery, MIGS, trabecular microbypass stent, surgical glaucoma, primary open-angle glaucoma

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