Using multiple trabecular micro-bypass stents in cataract patients to treat open-angle glaucoma

Belovay, Graham W.; Naqi, Abdulla; Chan, Brian J.; Rateb, Mahmoud; Ahmed, Iqbal Ike K.

doi:10.1016/j.jcrs.2012.07.017

Cited by 166 publications

(121 citation statements)

References 15 publications

Supporting

Mentioning

111

Contrasting

Unclassified

Order By: Relevance

“…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. 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.…”

Section: Discussionmentioning

confidence: 97%

“…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: 99%

See 1 more Smart Citation

Manchester iStent study: 3-year results and cost analysis

Tan

2016

Eye

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Manchester iStent study: 3-year results and cost analysis

Tan

2016

Eye

View full text Add to dashboard Cite

show abstract

“…These procedures have the attraction of an excellent safety profile albeit less overall effective IOP reduction when compared with phaco-DS in our study. 22,[40][41][42][43][44] Although the glaucoma community must watch and wait for the long-term results of these procedures, phaco-DS currently represents a safe and effective means of combining cataract and glaucoma surgery in the present, with a proven long-term track record.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of combined phacoemulsification and deep sclerectomy: a 10-year UK single-centre study

Mercieca

Shevade

Anand

2015

Eye

View full text Add to dashboard Cite

Purpose To report the outcomes of combined phacoemulsification and -deep sclerectomy (phaco-DS) from a single UK centre over a 10-year period. Methods Retrospective analysis of phaco-DS data extracted from an ongoing glaucoma surgery database within Calderdale and Huddersfield NHS Trust. Two hundred and ninety-six eyes of 282 patients were included. Data included patient demographics, pre-and postoperative intraocular pressure (IOP), use of mitomycin C (MMC), spacer device implantation, and follow-up details including surgical success rates. IOP success criteria were: (A) IOP o19 mm Hg and/or 20% decrease from baseline and (B) IOP o16 mm Hg and/or 30% drop from baseline. Results Mean follow-up was 63.5 ± 35.3 months. MMC was applied in 145 eyes (49%). Kaplan-Meier success rates in all eyes for criteria A were 89.1% and 80% with glaucoma medications (qualified success) and 81.2% and 68.3% without medications (unqualified success) at 2 and 5 years, respectively. Qualified success for criteria B was 72.4 and 61.4% and unqualified rates were 67.2 and 55.2% for the same time periods. Repeatedmeasures ANOVA showed significantly lower IOP in the phaco-DS with MMC group up to 3 years postoperatively (P = 0.002). Cox's proportional hazards for criteria B, however, showed no significant effect of MMC application in the long term (P = 0.2). Increasing age and laser goniopuncture were positively associated with success, whereas the absence of spacer devices was negatively associated. At last follow-up, 20% of eyes were on glaucoma medications. Complication rates were low with hypotony rates of 0.68%. Conclusions This study confirms the longterm safety and efficacy of phaco-DS as a primary glaucoma procedure.

show abstract

“…Numerous studies have assessed outcomes for up to 5 years following implantation of the first U.S. Food and Drug Administration‐approved trabecular micro‐bypass device, the iStent® Trabecular Micro‐Bypass (Glaukos Corporation – San Clemente, CA, USA). These data have demonstrated that implanting single1, 2, 3, 4 or multiple5, 6, 7, 8 first‐generation iStent devices, either with or without cataract surgery, can provide long‐term IOP and medication reduction in patients with mild to moderate glaucoma. In addition, MIGS procedures with these stents have demonstrated a positive benefit‐to‐risk profile in comparison to that of filtering surgeries9 or suprachoroidal stent placement 10, 11…”

Section: Introductionmentioning

confidence: 95%

Implantation of two second‐generation trabecular micro‐bypass stents and topical travoprost in open‐angle glaucoma not controlled on two preoperative medications: 18‐month follow‐up

Berdahl

Voskanyan

Myers

et al. 2017

Clinical Exper Ophthalmology

View full text Add to dashboard Cite

ImportanceAdditional data are sought regarding treatment options for glaucoma, a major cause of global blindness.BackgroundThe study assessed outcomes following standalone implantation of two second‐generation trabecular micro‐bypass stents and postoperative topical prostaglandin in eyes with open‐angle glaucoma not controlled on two preoperative medications.DesignThe study design is a prospective, nonrandomized, open‐label study at a tertiary‐care ophthalmology centre.ParticipantsSubjects had open‐angle glaucoma with preoperative intraocular pressure of 18–30 mmHg on two medications, a medication washout phase, and post‐washout intraocular pressure of 22–38 mmHg. All subjects (N = 53) have been followed for 18 months.MethodsOne day following implantation of two second‐generation trabecular micro‐bypass stents, subjects started topical travoprost. Medication washout was repeated at month 12.Main Outcome MeasuresThe main outcome measure was the proportion of eyes with intraocular pressure reduction ≥ 20% versus medicated baseline intraocular pressure with reduction of one medication at 12 months.ResultsAt 12 months, 91% of eyes achieved intraocular pressure reduction ≥ 20% with reduction of one medication. All eyes had intraocular pressure ≤ 18 mmHg with reduction of one medication, and 87% had intraocular pressure ≤ 15 mmHg. Mean intraocular pressure on one medication was ≤ 13.0 mmHg (≥ 34% reduction) through 18 months. Mean post‐washout intraocular pressure at month 13 was 33% lower than preoperative unmedicated intraocular pressure. No adverse events occurred through 18 months.Conclusions and RelevanceIn open‐angle glaucoma eyes on two preoperative medications, treatment with two second‐generation trabecular stents and one postoperative prostaglandin resulted in mean intraocular pressure ≤ 13 mmHg with reduction of one medication, with favourable safety. These findings show the utility of second‐generation trabecular bypass with postoperative prostaglandin in patients with open‐angle glaucoma.

show abstract

Using multiple trabecular micro-bypass stents in cataract patients to treat open-angle glaucoma

Abstract: Dr. Ahmed is a consultant to Glaukos Corp. No other author has a financial or proprietary interest in any material or method mentioned.

Cited by 166 publications

References 15 publications

Manchester iStent study: 3-year results and cost analysis

Manchester iStent study: 3-year results and cost analysis

Outcomes of combined phacoemulsification and deep sclerectomy: a 10-year UK single-centre study

Implantation of two second‐generation trabecular micro‐bypass stents and topical travoprost in open‐angle glaucoma not controlled on two preoperative medications: 18‐month follow‐up

Contact Info

Product

Resources

About