Outcomes of phacoemulsification combined with two iStent inject trabecular microbypass stents with or without endocyclophotocoagulation

Abstract

AimComparing outcomes after combined phacoemulsification, two iStents insertion and endocyclophotocoagulation (ECP) versus phacoemulsification-iStents alone.MethodsThis is a longitudinal retrospective 12 months study in eyes with ocular hypertension or early-to-moderate open angle glaucoma. Level of disease, intraocular pressure (IOP) and tolerance of glaucoma medication were considered before planning surgery. Best-corrected visual acuity (BCVA-logMAR), IOP (mm Hg), number of medications were assessed at baseline, week 1, week 5, month 3, 6, 12 postop. Main outcome: percentage (%) in IOP reduction at 12 months vs medicated baseline. Secondary outcomes: absolute values of IOP/medication reduction, BCVA and postop complications.ResultsThe ICE2 (two iStents-cataract extraction-ECP) group included 63 eyes and Phaco-iStent group included 46 eyes. Baseline IOP was higher in the ICE2 than phaco-iStent group (19.97±4.31 mm Hg vs 17.63±3.86 mm Hg, p=0.004) and mean deviation was lower (−7.20±2.58 dB vs −4.94±4.51 dB, p=0.037). Number of medications were comparable at baseline: 2.22±1.06 (ICE2) vs 2.07±1.02 (phaco-iStent), p=0.442. At month 12 postop, IOP in the ICE2 group decreased 35% from baseline vs 21% in the phaco-iStent group (p=0.03); absolute IOP reduction was significantly lower than baseline in each group (p<0.001), yet final IOP was lower in the ICE2 group than phaco-iStent group (13.05±2.18 mm Hg vs 14.09±1.86 mm Hg, p=0.01). Similar results were found for glaucoma medication (1.24±1.05 in ICE2 group vs 1.39±1.03 in phaco-iStent group, p=0.01). Final BCVA was 0.11±0.18 (phaco-iStent group) vs 0.08±0.08 (ICE2 group), p=0.309. Safety outcomes were comparable between groups.ConclusionICE2 procedure offers better results in IOP/medication reduction at 12 months than phacoemulsification-iStents alone.

Minimally invasive glaucoma surgery - current and emerging techniques to reduce intraocular pressure and medications

“…Medications were also reduced from 2.22 ± 1.6 to 1.24 ± 1.05 in the ECP group and from 2.07 ± 1.02 to 1.39 ± 1.03 in the phaco-iStent alone group, a comparable reduction in both, and safety results were also comparable. These results appear promising for the utilisation of ECP as a combined procedure with other MIGS and cataract surgery [21] .…”

“…Key statistics on mechanism of action, effectiveness, and safety profile were extracted for each type of MIGS (an overview of these findings summarised in Table 2). Analysed procedures were limited to Schlemm's canal iStent Hooshmand et al [5] Ferguson et al [6] Ferguson et al [7] Ahmed et al [8] Katz et al [9] + Hooshmand et al [5] Samuelson et al [10] + CE + CE Samuelson et al [4] Ahmed et al [8] + CE + CE Davids et al [11] Heersink et al [12] +/-CE Esfandiari et al [13] Avar et al [14] + CE +/-CE Elmallah et al [16] + CE RCS 315 eyes 12 mo: -27.47 12 mo: -1.03 Supraciliary space/ciliary process CyPass Vold et al [17] Reiss et al [18] Fard et al [19] Fard et al [19] + Myers et al [20] + 2 iStent PCS 80 subjects 48 mo: -41.36 n/a ECP Pantalon et al [21] + CE + 2 iStent PCS 63 eyes 12 mo: -34.65 12 mo: -0.98 Subconjunctival space XEN Gel Stent Olgun et al [15] Karimi et al [22] Wagner et al [23] Gillmann et al [24] +…”

“…ECP is generally indicated in end-stage glaucoma. Pantalon et al [21] have demonstrated the efficacy of ECP through conducting a 12-month retrospective study with patients receiving either 2 iStents, with concurrent ECP and cataract extraction, or phacoemulsification and 2 iStents alone. The ECP procedure proved efficacious in reducing IOP from a baseline value of 19.97 ± 4.31 mmHg to 13.05 ± 2.18 mmHg (a 35% reduction) compared with 17.63 ± 3.86 mmHg to 14.09 ± 1.86 mmHg (a 21% reduction) in the phacoemulsification and 2 iStent alone group.…”

Success of Primary Trabeculectomy in Advanced Open Angle Glaucoma

“…12 Recently a "triple procedure" (phacoemulsification, iStent inject ® trabecular micro-bypass insertion and endoscopic cyclophotocoagulation) offered IOP reduction of 35% from baseline in early-to-moderate glaucoma eyes at 12 months follow-up. 22 However, in advanced glaucoma eyes, lower target pressures (low teens = 8-10 mmHg) are required, which can still best be achieved by trabeculectomy, offering 40-50% IOP reduction from baseline and various long-term success rates, according to definitions and follow-up interval. [23][24][25][26] Postoperative complications are often described, of which excessive healing leading to surgical failure is the most feared.…”

Combination microinvasive glaucoma surgery: 23-gauge cystotome goniotomy and intra-scleral ciliary sulcus suprachoroidal microtube surgery in refractory and severe glaucoma: A case series

“…At 12 months follow-up, the ICE2 group achieved a greater IOP reduction of 6.92 mmHg (35% from baseline) in comparison to 3.54 mmHg (21% from baseline) in the Phaco-iStent group. [ 6 ]…”