Influence of oral anticoagulation on success rates and risk of bleeding events after iStent inject implantation combined with phacoemulsification

Widder, Randolf A.; Lappas, Alexandra; Rennings, Corinna; Hild, Matthias; Roessler, Gernot; Dietlein, Thomas S.

doi:10.1007/s00417-020-04894-3

Cited by 6 publications

(6 citation statements)

References 14 publications

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“…However, the postsurgical IOP in this study was not affected by the spike as analyzed by the Cox proportional hazard ratio model ( Table 5 ). As was reported previously, 28 effects of postsurgical hyphema and IOP spike may be short and only a minor factor on the final surgical outcome.…”

Section: Discussionsupporting

confidence: 73%

<p>Turn Back Elevation of Once Reduced IOP After Trabeculotomy Ab Externo and Kahook Dual Blade Surgeries Combined with Cataract Surgery</p>

Chihara¹,

Chihara

2020

OPTH

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Purpose To evaluate the surgical outcome of internal trabeculectomy by Kahook dual blade (KDB) with that of external trabeculotomy, each combined with phaco-lensectomy and intraocular lens implantation (Phaco). Patients and Methods This is a retrospective comparative study. The primary and secondary outcome measures are postsurgical intraocular pressure and postsurgical hyphema. One eye each of 76 primary open angle glaucoma (POAG), pseudoexfoliation glaucoma (PEG) and ocular hypertension (OH) patients underwent external phaco-trabeculotomy, and that of 40 POAG, PEG and OH patients underwent phaco-KDB surgery. Results Reduction of the intraocular pressure (IOP) by phaco-KDB at one and two years was 28.4 and 27.8%, respectively, and was not significantly different from that by external phaco-trabeculotomy of 32.7% ( P =0.256) and 31.5% ( P =0.468), respectively. Three months postsurgical IOP after phaco-KDB and external phaco-trabeculotomy was 16.1 and 15.9 mmHg, respectively. There was a significant turn back elevation of once reduced IOP to 17.1 ( P =0.0207) and 17.0 mmHg ( P =0.0096) at 24 months, respectively. There were no differences in success probability to achieve IOP below 17 mmHg ( P =0.120), 21 mmHg ( P =0.719) and >20% IOP reduction ( P =0.309) with medication(s) at two years between the phaco-KDB and external phaco-trabeculotomy cohorts. Younger age was a significant ( P <0.001) risk factor for failure; however, presurgical IOP ( P =0.466), the type of surgery ( P =0.219) and presence of postsurgical IOP spike ( P =0.737) were not significant risk factors by the Cox proportional hazard model. Hyphema and spike of the IOP in phaco-KDB and external phaco-trabeculotomy cohorts were 40% and 88% ( P <0.001), and 53% and 41% ( P =0.238), respectively. Conclusion The IOP reduction by the phaco-KDB was equivalent to that by external phaco-trabeculotomy up to two years. In both cohorts, once reduced postsurgical IOP tend to increase up to 24 months.

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Section: Discussionsupporting

confidence: 73%

<p>Turn Back Elevation of Once Reduced IOP After Trabeculotomy Ab Externo and Kahook Dual Blade Surgeries Combined with Cataract Surgery</p>

Chihara¹,

Chihara

2020

OPTH

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“…Even though over 30% of included patients were on oral anticoagulation therapy at the time of surgery, we did not see any association between anticoagulation therapy and hyphema, which is in line with previous studies. 20,21 Thus, our results indicate FIGURE 5. Reduction of ≥ 1 medication after 2 years.…”

Section: Discussionsupporting

confidence: 59%

Outcomes of iStent Inject Versus Kahook Dual Blade Surgery in Glaucoma Patients Undergoing Cataract Surgery

Barkander

Economou

Jóhannesson

2023

Journal of Glaucoma

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Précis: iStent Inject implantation (iStent) or Kahook Dual Blade goniotomy (KDB) in combination with phacoemulsification have a similar IOP-lowering effect in all stages of glaucoma, and medications are significantly reduced, especially after KDB.Purpose: To compare the 2-year efficacy and safety of iStent or KDB in combination with phacoemulsification in eyes with mild to advanced open angle glaucoma.Methods: A retrospective chart review of 153 patients that received iStent or KDB in combination with phacoemulsification at a single center between March 2019 and August 2020. The main outcome parameters at 2 years were: (1) intraocular pressure (IOP)-reduction ≥ 20%, with a postoperative IOP ≤ 18 mm Hg, and (2) a reduction of ≥ 1 medication. Results were stratified by glaucoma grade.Results: After 2 years, mean IOP was reduced from 20.3 ± 6.1 to 14.2 ± 4.1 mm Hg in the phaco-iStent group (P < 0.001) and from 20.1 ± 6.1 to 14.7 ± 3.6 mm Hg in the phaco-KDB group (P < 0.001). The mean number of medications was reduced from 3.0 ± 0.9 to 2.6 ± 1.1 in the Phaco-iStent group (P = 0.001) and from 2.3 ± 1.0 to 1.5 ± 1.3 in the Phaco-KDB group (P < 0.001). Success regarding IOP-reduction ≥ 20% with a postoperative IOP ≤ 18 mm Hg was met by 46% in the phaco-iStent group and by 51% in the phaco-KDB group. A reduction of ≥ 1 medication was met by 32% in the phaco-iStent group and by 53% in the phaco-KDB group (P = 0.013). Eyes with mild to moderate and advanced glaucoma responded equally well to the success criteria.Conclusions: iStent and KDB, in combination with phacoemulsification, both lowered IOP effectively in all stages of glaucoma. More medications were reduced after KDB, suggesting that it may be a more effective procedure compared with iStent.

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“…However, it recently was reported that these drugs do not interfere with the success rate of iStent inject implantation. 16 Notably, first eyes showed a higher mean baseline IOP than second eyes. The reason for this might be that, if trabecular bypass stent implantation is indicated for both eyes according to our standard operating procedures, surgery is commonly performed for the eye with the higher IOP first, which in turn may be responsible for a higher relative IOP-reduction and, hence, higher success rates.…”

Section: Discussionmentioning

confidence: 98%

“…Moreover, six out of all participants were under oral anticoagulation therapy. However, it recently was reported that these drugs do not interfere with the success rate of iStent inject implantation 16 …”

Section: Discussionmentioning

confidence: 99%

“…The implantation of two iStent inject stents was performed, as previously described. 16 After making a standard 1.6 mm clear cornea incision and anterior chamber stabilisation using viscoelastic substance, the trabecular meshwork was visualised through the back-tilted microscope using a modified Swan-Jacob lens. The injector device was then inserted through the tunnel and two iStent inject stents were placed in the nasal region of Schlemm's canal.…”

Section: Surgical Techniquementioning

confidence: 99%

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Predictability of success for combined iStent inject trabecular bypass implantation with phacoemulsification in the subsequent eye

Kiessling

Rennings

Hild

et al. 2023

Clinical Exper Ophthalmology

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Background: To investigate in combined iStent inject implantation with phacoemulsification carried out bilaterally, whether intraocular pressure (IOP)lowering effectiveness in the first eye has a predictive potential for the outcome of the second eye in primary open-angle glaucoma (POAG).Methods: This retrospective study included 72 eyes from 36 participants, who underwent trabecular bypass implantation in combination with cataract surgery at two study centres (Düsseldorf, Cologne). Surgery was classified as either 'success' or 'failure' based on three scores: IOP at follow-up <21 mmHg (Score A) or IOP < 18 mmHg (Score B), with an IOP reduction >20% respectively, without re-surgery and IOP ≤ 15 mmHg with an IOP reduction ≥40%, without re-surgery (Score C). Results:The IOP lowering outcomes of first and second eyes did not differ significantly. There was a significantly higher chance of success in the second eye after effective surgery in the first eye compared with cases after a preceding failure. Within our cohort, a 76% probability of success for the subsequent eye was determined following prior success for Score A. This probability was reduced to 13% if surgery in the first eye failed. The respective probabilities were 75% and 13% for Score B and 40% and 7% for Score C. Conclusions:In bilateral trabecular bypass implantation combined with cataract surgery, there is a high predictive potential for subsequent eyes based on the extent of IOP-lowering in the initial eye, which should be considered by the surgeon for second eye surgeries.

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Influence of oral anticoagulation on success rates and risk of bleeding events after iStent inject implantation combined with phacoemulsification

Cited by 6 publications

References 14 publications

<p>Turn Back Elevation of Once Reduced IOP After Trabeculotomy Ab Externo and Kahook Dual Blade Surgeries Combined with Cataract Surgery</p>

<p>Turn Back Elevation of Once Reduced IOP After Trabeculotomy Ab Externo and Kahook Dual Blade Surgeries Combined with Cataract Surgery</p>

Outcomes of iStent Inject Versus Kahook Dual Blade Surgery in Glaucoma Patients Undergoing Cataract Surgery

Predictability of success for combined iStent inject trabecular bypass implantation with phacoemulsification in the subsequent eye

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