Clinical Ophthalmology (Sep 2022)

Clinical and Visual Field Outcomes Following Minimally Invasive Glaucoma Surgery Combined with Cataract Surgery

  • Turner ML,
  • Taha AM,
  • Yonamine S,
  • Yu Y,
  • Saifee M,
  • Yang M,
  • Ying GS,
  • Han Y,
  • Oatts JT

Journal volume & issue
Vol. Volume 16
pp. 3193 – 3203

Abstract

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Marcus L Turner,1 Abu M Taha,1 Sean Yonamine,1 Yinxi Yu,2 Murtaza Saifee,1 Mike Yang,3 Gui-Shuang Ying,2 Ying Han,1 Julius T Oatts1 1Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA; 2Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; 3Prism Eye Institute, Oakville, ON, CanadaCorrespondence: Julius T Oatts, Department of Ophthalmology, University of California, San Francisco, 490 Illinois Street, San Francisco, CA, 94158, USA, Tel +1 415 353 2800, Fax +1 415 353 2468, Email [email protected]: To determine the change in Humphrey visual field and clinical parameters after minimally invasive glaucoma surgery combined with cataract surgery.Patients and Methods: Patients undergoing minimally invasive glaucoma surgery combined with cataract surgery in a multicenter retrospective case series between 2013 and 2021 with reliable preoperative and 12 to 18 month postoperative visual field measurements were included. Devices included iStent, XEN, and Hydrus. Clinical parameters were compared with a generalized linear model with generalized estimating equations between preoperative and postoperative visits including best corrected visual acuity, intraocular pressure, number of glaucoma medications and visual fields. Visual field metrics included mean deviation (MD), pattern standard deviation (PSD), visual field index (VFI), and Collaborative Initial Glaucoma Treatment Study (CIGTS) score of total deviation probability and pattern deviation probability.Results: Forty-four eyes from 39 patients were included. During the follow up period, visual acuity improved from 0.23± 0.17 to 0.10± 0.14 logMAR (mean ± standard deviation, p< 0.001), number of glaucoma medications was reduced from 2.68± 1.06 to 1.46± 1.32 (p< 0.001), and intraocular pressure decreased from 17.08± 4.23 mmHg to 14.92± 3.13 mmHg (p=0.003). Differences across devices were negligible. The only significant difference was a greater reduction in number of glaucoma medications in the XEN group (p< 0.001). There were no significant changes in the global parameters of VFI, MD, PSD, or CIGTS.Conclusion: Overall, minimally invasive glaucoma surgery combined with cataract surgery appears to be effective at stabilizing visual field function, reducing intraocular pressure, reducing number of glaucoma medications, and improving visual acuity over a 12 to 18 month follow-up period across MIGS devices.Keywords: glaucoma, MIGS, visual field, cataract

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