Three year results of iStent + phacoemulsification cataract surgery for glaucoma

Abstract

PurposeTo evaluate long‐term safety and efficacy of iStent trabecular micro‐bypass stent implantation + cataract surgery (phaco) in glaucoma: A retrospective, interventional, open label study.MethodsCases of glaucoma who had phacoemulsification surgery planned, were included. Preoperative and postoperative evaluations included intra‐ocular pressure (IOP), topical ocular hypotensive agent use, best corrected visual acuity, perioperative complications and adverse events.ResultsA single trabecular micro‐bypass iStent was implanted at the time of phacoemulsification cataract surgery. A temporal incision approach was used in all cases. The results from 35 eyes in 25 patients were analysed for 3 years postoperatively. 49% (n = 17) were male. Mean age was 80 ± 7 (SD). 3 eyes had angle closure with previous peripheral iridotomies.Mean preoperative IOP was 18.5 ± 3.2 mmHg; this was significantly reduced at 12 months (p = 0.008), 24 months (p=<0.001) and 36 months (p=<0.001). Mean IOP was 15.9 ± 4.5, 15.0 ± 4.5 and 15.6 ± 3.6 respectively. The mean number of preoperative IOP lowering agents was 2.3 ± 1.0 and 2.5 ± 1.0 at 36 months. This was not significantly reduced at any follow up time period. Secondary interventions were required in three eyes. Cyclodiode laser was required in 2 patients. ALT was carried out in 2 eyes. There were no significant intraoperative complications and no post‐operative hypotony. At 36 months, visual acuity was ≥6/12 in 29 eyes (83%).ConclusionsTrabecular micro‐bypass stent implantation during cataract surgery is safe and effective for patients with glaucoma. We measured a sustained reduction in IOP over 36 months in the real world clinic setting.