Phaco-Trabecular Micro-Bypass Stent in Management of Patients With Advanced Open-Angle Glaucoma
Narrative Responses:
Purpose
To investigate the efficacy and safety of Phaco-iStent for intraocular pressure (IOP) control in patients with advanced stage open angle glaucoma (OAG).
Methods
Retrospective case series of patients with advanced OAG undergoing phacoemulsification combined with two iStents (phaco-iStent) between August 2011 and February 2013 at a University-affiliated hospital, with at least 6 months follow-up. Included were 51 eyes of 41 patients. Two patients had prior filtering surgery. Cases were identified by reviewing billing codes, and cross-checking with booked surgical lists. The primary study outcome was IOP reduction and change in number of glaucoma medications at 6 and 12 months follow-up. Success criteria was: no need for additional surgery, IOP maintained ≤ 14 mmHg with or without glaucoma medications, throughout 12 months follow-up.
Results
Pre-operative IOP was 17.9 ± 5.4 (9-32) and pre-operative number of medications was 2.12 ± 1.32 (0-4). At 6 months (n=51) there was a significant reduction in IOP of 4.1 mmHg (13.8 +/-3.40; p<0.001); number of medications was reduced to 1.84 +/-1.02 (p<0.01). At 12 months (n=25) there was a significant reduction in IOP of 5.3 mmHg (12.56 +/-3.50; p<0.001); number of medications 2.00+/-1.16 (p<0.01). Early complications included one patient with hyphema and one patient with IOP spike greater than 21 mmHg. The success rate was 76.5% (4 patients required additional filtering surgery, 8 patients did not meet IOP requirement).
Conclusion
Previous studies have evaluated phaco-istent in early-moderate glaucoma patients. Our study shows within one year after treatment, phaco-iStent appears efficacious and safe; this provides early support for a potential off-label indication for phaco-iStent in select advanced OAG patients. However further prospective comparative studies are needed.