Coexistent primary open-angle glaucoma and cataract: Preliminary analysis of treatment by cataract surgery and the iStent trabecular micro-bypass stent

Spiegel, D.; García‐Feijoó, Julián; García–Sánchez, J.; Lamielle, Helene

doi:10.1007/s12325-008-0062-6

Cited by 87 publications

(69 citation statements)

References 18 publications

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“…10 This was also the experience of Le et al 12 who recommended early tapering of steroids. Steroid response may partly explain the delay in the peak IOP lowering effect following iStent insertion, usually at 3 months post-insertion, 7,11 which was also what we found in our study. There was no long-term adverse event in the 3-year follow-up period in our study group, suggesting that the procedure is a safe and effective longterm method of lowering IOP.…”

Section: Discussionsupporting

confidence: 86%

“…4,10 Among other adverse events reported in studies are stent malposition or occlusion early in the post-operative period, affecting 4% to 18% of cases but usually resolved with observation alone or secondary procedures such as Nd:YAG laser, argon laser gonioplasty, recombinant tissue plasminogen activator, stent repositioning, or stent replacement. 10,11 Steroid response was found in 2 of 53 eyes 4 weeks post-operatively in a case series where IOP was controlled after cessation of steroids. 10 This was also the experience of Le et al 12 who recommended early tapering of steroids.…”

Section: Discussionmentioning

confidence: 98%

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Manchester iStent study: 3-year results and cost analysis

Tan

2016

Eye

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Purpose To evaluate the safety, efficacy, and the cost of combined phacoemulsification and single iStent insertion in open angle glaucoma (OAG) at 3-years follow-up. Methods This was a prospective, uncontrolled, interventional case series. All subjects underwent single iStent implantation combined with cataract surgery by a single surgeon and were followed up over 3 years. Primary outcome measures were the reduction in intraocular pressure (IOP) and number of glaucoma drops at 1, 2, and 3 years. The costs of the procedure vs the cost of continuation of glaucoma drops were calculated and compared in patients who completed 3-years follow-up. Results Forty-one patients were included in the study and thirty-six patients completed 3-years follow-up. Mean pre-op IOP was 21.2 mm Hg on 2.1 medications. Mean IOP was reduced to 15.9 mm Hg on 0.5 drops, 16.1 mm Hg on 1.0 drops, and 17.1 mm Hg (Po0.001) on 1.3 drops (Po0.001) at 1, 2, and 3 years, respectively. The overall cost of combined cataract surgery and iStent was estimated to be £829.32 more in total than conservative management with brand name eye drops over 3 years (£7.70 per patient per year) and £14 176.9 more if generic drops were used. (£131.3 per patient per year). Conclusions Combined phaco-iStent proved to be a safe and effective way of managing patients with OAG over our 3-year follow-up period. The cost-effectiveness of the procedure may vary depending on whether brand name or generic eye drops are used.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 98%

Manchester iStent study: 3-year results and cost analysis

Tan

2016

Eye

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“…10 By comparison, phacotrabeculectomy reduces IOP mean by 8.2mmHg. Conjunctiva is reflected, and a scleral flap is cut as in a trabeculectomy.…”

Section: Ab-interno Micro Stent To Bypass Trabecular Resistancementioning

confidence: 98%

Cataract Surgery in the Glaucoma Patient

Poley¹,

Lindstrom²,

Samuelson³

et al. 2011

US Ophthalmic Review

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According to Research to Prevent Blindness, 20.5 million US citizens have cataract, and two million are visually impaired with glaucoma. Today, we operate on approximately three million cataracts a year, and 10% of these patients have co-existing glaucoma; so, 300,000 times a year, a US surgeon must decide how to treat a patient with co-existent cataract and glaucoma. Treatment Has Changed for Co-existent Cataract and Glaucoma During the Past 70 YearsFrom 1940 to 1975 the predominant method of cataract removal was intracapsular surgery. Since intracapsular surgery entailed removing the lens capsule, the lens capsule could no longer serve as a barrier between the anterior vitreous and aqueous. Without this barrier, vitreous mixed with aqueous in the anterior chamber in many aphakic eyes, and caused many fistulas of glaucoma operations to fail if glaucoma surgery was performed after the cataract was removed. Also, the limbal incision through conjunctiva and sclera made with intracapsular surgery created scleral/conjunctival scarring that increased the failure of subsequent glaucoma operations. Therefore, when patients had co-existent cataract and uncontrolled glaucoma, glaucoma surgery was always carried out before the cataract was removed. Glaucoma Bleb SurgeryThe first successful operations for open-angle glaucoma created an alternative channel for aqueous egress from the eye that bypassed the eye's failing trabecular meshwork (TM) and Schlemm's canal (SC). The operation created a fistula at the limbus through corneal-scleral tissue that drained aqueous from the anterior chamber, and created a bleb beneath Tenon's capsule and conjunctiva. The bleb drained posteriorly into the orbital lymphatics. AbstractThis article describes the changing treatment of co-existent cataract and glaucoma over the past 70 years. Seventy years ago, the cataract was removed using an intracapsular technique. Glaucoma was always controlled with a scleral fistulizing operation before the cataract was removed.In 1975, Charles Kelman introduced phacoemulsification. When clear corneal incisions were introduced for phacoemulsification, glaucoma surgery no longer needed to precede cataract surgery. The combined procedure of phacoemulsification/lens implantation and trabeculectomy became popular 10 years ago. Recently, non-bleb treatments for glaucoma have emerged that eliminate the problems associated with trabeculectomy. These procedures include phaco/intraocular lens (IOL) alone, trabectome, iStent ® , and canaloplasty. A major cause of adult glaucoma, the enlarging crystalline lens as it ages, was recognized in 2007. Greater IOP reductions following phaco/IOL alone were discovered at this time. Phaco/IOL may emerge as the preferred treatment of co-existent cataract and glaucoma. Trabectome can be added to phaco/IOL if greater IOP reduction is needed.

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“…The ocular hypotensive efficacy seen with the stent in this study was found to be consistent with the trabecular bypass mechanism of action and results described in literature. (Fea, 2010;Spiegel et al, 2008Spiegel et al, & 2009 Compared with cataract surgery alone, implantation of the iStent concomitant with cataract extraction significantly increases trabecular outflow facility, reduces IOP and the number of medications. (Fernandez-Barrientos et al, 2010) A study in cultured human anterior segments has shown that a single stent created the largest change in IOP, resulting in a mean of 12.4 ± 4.2 mm Hg, corresponding to an 84% increase in facility of outflow.…”

Section: Scientific Evidence So Farmentioning

confidence: 99%