Treatment of Open-Angle Glaucoma with iStent Implantation Combined with Phacoemulsification in Polish Caucasian Population

Kozera, Milena; Konopińska, Joanna; Mariak, Zofia; Rękas, Marek

doi:10.2147/opth.s293637

Cited by 8 publications

(13 citation statements)

References 32 publications

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“…Another surgical method bypassing the trabecular meshwork is the iStent inject device. A prospective case series on 78 eyes evaluated the surgical outcome of iStent in combination with phacoemulsification [ 22 ]. Complete success was attained at approximately 40% after 1 year and 35.1% after 2 years, with a mean follow-up time of 21.9 months and a mean preoperative IOP of 18.4 mmHg (±3.5).…”

Section: Discussionmentioning

confidence: 99%

Reassessing Trabeculectomy: A Long-Term Study with Stringent Success Criteria

Braun,

Böhringer,

Jordan

et al. 2024

JCM

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Background: The aim was to evaluate the long-term outcome and efficacy of primary trabeculectomy with adjunctive mitomycin c (MMC) for treating glaucoma. Methods: We examined the medical records of 286 eyes that underwent trabeculectomy between 2008 and 2009 at the University Eye Hospital in Freiburg, Germany. Preoperative and follow-up data were collected, including intraocular pressure (IOP) measurements, surgical glaucoma interventions, and prescribed glaucoma medication. The first success criterion was defined as IOP ≤ 15 mmHg with no use of pressure-lowering medication by the patient, the second criterion was defined as the absence of surgical revision, and the third criterion as no further IOP-lowering surgery excluding early revisions following trabeculectomy. Statistical analyses comprised Cox regression and Kaplan–Meier survival estimations. Results: The mean follow-up duration was 1841 days (5 years). The mean preoperative IOP was 26.1 mmHg. Evaluating the success criteria at the time of average follow-up yielded a success rate of only 25% for the first criterion but 80% for both the second and third success criteria. Conclusions: The findings suggest that trabeculectomy with adjunctive MMC can be an effective procedure for permanently lowering IOP. However, surgical revisions and/or further glaucoma surgeries might still be needed. The long-term success rate is lower in comparison to previous research, which may be explained by the stricter success criteria in our study.

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Section: Discussionmentioning

confidence: 99%

Reassessing Trabeculectomy: A Long-Term Study with Stringent Success Criteria

Braun,

Böhringer,

Jordan

et al. 2024

JCM

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“…The technique for surgical implantation of first-generation iStent was performed as described elsewhere [ 19 , 20 , 21 , 22 , 23 ].…”

Section: Methodsmentioning

confidence: 99%

“…The iStent is a heparin-coated, non-ferromagnetic titanium stent that is implanted into the TM using an ab interno approach. Multiple studies have demonstrated the effectiveness of iStent at lowering IOP and medication reduction in patients undergoing cataract surgery [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Selective Laser Trabeculoplasty after iStent Implantation in Primary Open-Angle Glaucoma

Siedlecki

Hicks

Haaland

et al. 2021

JPM

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iStent implantation is thought to augment the trabecular outflow channel in the anterior segment of the eye. We hypothesized that iStent with subsequent selective laser trabeculoplasty (SLT) would better control the intraocular pressure (IOP) compared to standalone SLT in patients with primary open-angle glaucoma (POAG). We, therefore, determined if the presence of an iStent combined with SLT was statistically associated with IOP lowering compared to standalone SLT. Through retrospective electronic medical record review, records of 824 eyes from 440 patients who received primary SLT without a history of iStent were considered. Additionally, 42 eyes from 28 patients who received SLT after combined phacoemulsification and iStent implantation that failed to control intraocular pressure (IOP) and/or the progression of the disease were retrospectively reviewed. IOP and number of medications, which were tracked in each patient for up to 12 months post laser, were also examined. Successful outcome was defined as a statistically significant reduction in IOP or number of medications at 6 months. As defined in univariate analysis (p ≤ 0.01), multivariate analysis included iStent, age, sex, race, and initial IOP as variables. IOP reduction was statistically associated with patients pre-SLT IOP (p < 0.001) but not with patients with iStent (p = 0.222). Medication reduction was statistically associated with the pre-SLT number of medications (p < 0.001) and iStent (p < 0.001). In eyes that received SLT, iStent was not statistically associated with a greater reduction in IOP compared to controls, but was associated with a higher reduction in the overall number of medications used 6 months after receiving SLT. The work presented should guide clinicians to consider SLT as an effective therapy after iStent implantation, in terms of glaucoma medication reduction in iStent patients, but clinicians should know that the presence of an iStent does not necessarily make subsequent SLT more effective at lowering IOP.

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“…This underpins the development of "blebless" procedures, or minimally invasive glaucoma surgeries (MIGS) [11]. However, a reduction in the number of complications due to improvements in surgical methods allows for earlier decision for surgical treatment, resulting in permanent and safe control IOP [12,13] Ab externo canaloplasty belongs to the group of "blebless" procedures [14], whereas iStent is included in the MIGS group [15][16][17]. The common feature of this group of procedures is the lowering of IOP by improving the physiological mechanisms of aqueous humour outflow through the conventional pathway.…”

Section: Introductionmentioning

confidence: 99%

“…Studies on canaloplasty have reported a promising reduction in IOP, with only a few postoperative complications [12][13][14]. The effectiveness of iStent in different populations has been described extensively [15][16][17] and has been compared to various other procedures [18][19][20][21][22]. These studies have reported a mild hypotensive effect with a clear reduction in the burden of pharmacological treatment after the procedure [23][24][25][26][27].…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of ab Externo Phaco-Canaloplasty versus First-Generation iStent Bypass Implantation Combined with Phacoemulsification in Patients with Primary Open Angle Glaucoma-Early Results

Gołaszewska

Obuchowska

Konopińska

2023

IJERPH

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This study evaluated the early outcomes of the hypotensive efficacy and safety profile of ab externo phaco-canaloplasty versus first-generation iStent bypass implantation combined with phacoemulsification in patients with primary open-angle glaucoma (POAG). In total, 82 patients with POAG comprising 92 eyes were divided into phaco-canaloplasty (Group PC, (n = 47) or iStent combined with phacoemulsification (Group PiS, n = 45) groups. Primary outcome measures were intraocular pressure (IOP) reduction and number of glaucoma medications. Secondary outcome measures were best-corrected visual acuity (BCVA), endothelial cell density (EECD), changes in anterior chamber depth (ACD), and complication rate. The follow-up period was approximately 6 months. Preoperative IOPs were 17.30 (15.00; 19.85) mmHg and 17.50 (15.10; 20.90) mmHg in the PC and PiS groups, respectively (p = 0.876). At the end of the follow-up, IOP decreased to 15.00 (13.00; 16.00) mmHg and 15.00 (14.00; 17.00) mmHg in the PC and PiS groups, respectively (p = 0.438). Medication usage decreased from 2.08 to 0.12 and 1.40 to 0.04 in PC and PiS eyes, respectively. Most patients in both groups were medication-free at 6 months follow-up. After 6 months of observation, EECD in PC and PiS groups decreased from 2309.50 (2032.00; 2533.00) to 1966.50 (1262.00; 2353.50) and 2160.00 (1958.50; 2372.50), to1231.00 (1089.00; 2050.00), respectively (p = 0.037). Pre-surgery BCVA was 0.80 (0.50; 1.00) and 0.60 (0.40; 1.00) in PC and PiS eyes, respectively (p = 0.456). Follow-up BCVA was 0.95 (0.60; 1.00) for PC and 1.00 (1.00; 1.00) for PiS. Hyphema and corneal oedema were noted on the first day post-surgery in both groups. Subsequent complications included a transient increase in IOP in the PC group. Phaco-canaloplasty and iStent bypass implantation combined with phacoemulsification significantly lowered IOP and decreased medication burden. All eyes in both groups maintained or exhibited improved BCVA relative to baseline. Both surgeries had low postoperative complication rates and exhibited comparable safety profiles over 6-month follow-up in patients with POAG.

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Treatment of Open-Angle Glaucoma with iStent Implantation Combined with Phacoemulsification in Polish Caucasian Population

Cited by 8 publications

References 32 publications

Reassessing Trabeculectomy: A Long-Term Study with Stringent Success Criteria

Reassessing Trabeculectomy: A Long-Term Study with Stringent Success Criteria

Efficacy of Selective Laser Trabeculoplasty after iStent Implantation in Primary Open-Angle Glaucoma

Efficacy and Safety of ab Externo Phaco-Canaloplasty versus First-Generation iStent Bypass Implantation Combined with Phacoemulsification in Patients with Primary Open Angle Glaucoma-Early Results

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