Comparison of 1-Year Effectiveness of Trabecular Microbypass Stent implantation (iStent) in Conjunction With Phacoemulsification Among Mild, Moderate, and Severe Primary Open-angle Glaucoma Patients. Issue 7 (July 2020)

• Record Type: Journal Article
• Authors: Chansangpetch, Sunee; Ittarat, Mantapond; Yang, Shuo; Fisher, Ann C.; Singh, Kuldev; Lin, Shan C.; Chang, Robert T.
• Is Part Of: Journal of glaucoma. Volume 29:Issue 7(2020)
• Publication Date: 2020-07
• Subjects: trabecular microbypass stent -- primary open-angle glaucoma -- iStent -- glaucoma severities; Glaucoma -- Periodicals; 617.741005
• DOI: 10.1097/IJG.0000000000001542
• Languages: English
• ISSNs: 1057-0829

Abstract

Abstract : Precis: The study compared 1-year effectiveness of single trabecular microbypass stent (iStent) implantation with phacoemulsification among glaucoma severities in primary open-angle glaucoma. The study found that mild glaucoma had greater success rate and lower number of medications compared with moderate and severe glaucoma. Purpose: To evaluate the effectiveness of iStent implantation in combination with cataract surgery in moderate to severe glaucoma compared with mild glaucoma. Methods: Medical charts of primary open-angle glaucoma subjects undergoing 1 iStent implantation were retrospectively reviewed. Glaucoma was classified on the basis of mean deviation (MD) of the preoperative standard automated perimetry into mild (MD>−6 dB), moderate (MD −6 to −12 dB), and severe (MD<−12 dB). Mixed effect regression models were performed to determine the effect of iStent at 1 year. The outcomes included as follows: (1) intraocular pressure (IOP) and the number of medications, (2) eyes with IOP ⩽ severity-based target (18 mm Hg for mild, 15 mm Hg for moderate, 12 mm Hg for severe) (2A) without medication, and (2B) with medication reduction. Results: In total, 104 eyes from 89 subjects were analyzed. Cataract combined with iStent surgery significantly lowered the number of medications in all groups and significantly decreased IOP in moderate and severe glaucoma ( P <0.05). There was significantly higher number of medications in moderate (β: 0.58, P =0.002) and severe (β: 1.20, P <0.001) compared with mild glaucoma. Eyes with moderate glaucoma had significantly lower rate of success (criterion 2A) compared with mild glaucoma [odds ratio (OR): 0.008, P =0.047]. Eyes with moderate and severe glaucoma had significantly lower rates of success (criterion 2B) (moderate vs. mild OR: 0.002, P =0.028; severe vs. mild OR: 0.026, P =0.026). Conclusions: Combined phacoemulsification with iStent seems to have a better IOP-lowering and medication-lowering effect in mild glaucoma cases versus those with moderate and severe glaucoma. This difference was found in real-world data over one-year follow-up period. Long-term studies with defined IOP goals and medication removal protocols are warranted. Abstract : Supplemental Digital Content is available in the text.