Comparison of Combined Cataract Surgery With Trabecular Micro-Bypass Stent Versus Ab-Interno Micro-Cautery Trabeculotomy

Khan, Michelle

Comparison of Combined Cataract Surgery With Trabecular Micro-Bypass Stent Versus Ab-Interno Micro-Cautery Trabeculotomy

Saturday, April 26, 2014: 3:01 PM

Room 154 (Boston Convention and Exhibition Center)

Michelle Khan, BSc(Hons), Queen's School of Medicine, Kingston, Ontario, Canada

Hady Saheb, MD, MPH, McGill University, Montreal, QC, Canada

Arvind Neelakantan, MD, FRCOphth, Glaucoma Center of Texas, Dallas, TX, USA

Ronald L. Fellman, MD, Glaucoma Associates of Texas, Dallas, TX, USA

Zachary D. Vest, MD, Colorado Eye Institute, Colorado Springs, CO, USA

Paul J. Harasymowycz, MD, University of Montreal, Montreal, QC, Canada

Ike K. Ahmed, MD, University of Toronto, Mississauga, ON, Canada

Narrative Responses:

Purpose
To evaluate and compare the intraocular pressure, medication reduction, and post-operative complications of trabecular micro-bypass stent versus ab-interno micro-cautery trabeculotomy when combined with cataract surgery in patients with open angle glaucoma.

Methods
49 patients that underwent combined phaco and 2 trabecular micro-bypass stents (iStents, Glaukos Corp, Laguna Hills, CA) (Group i) and 52 patients with combined phaco and ab-intero micro-cautery trabeculotomy (Trabectome, NeoMedix, Tustin CA) (Group t) with 12-month follow-up were included. Efficacy measures were intraocular pressure (IOP), topical ocular hypotensive medication use, and frequency of post-operative complications.

Results
A significant decrease in both IOP and medication use occurred in both groups. Postoperative IOP (p= 0.008) and medication use (p< 0.01) were significantly lower in Group i vs. Group t. 39% of patients in Group i and 14% in Group t had an IOP< 18 on no medications at 12 months (p= 0.03). There were no differences between the groups for preoperative IOP (p= 0.39) and medication use (p=0.82). In terms of post-operative complications, the occurrence of hyphema was significantly less in Group i (p= 0.008).

Conclusion
Both groups showed a significant reduction of IOP and medication use over a 12-month period. Combined phaco and micro-stents showed lower IOP, less medication use, and reduced frequency of hyphema formation post-operatively compared to combined phaco and micro-cautery trabeculotomy.