Second-Generation, Two-Stent Injection Lowers IOP and Medication Burden in Various Glaucoma Types
by: Shuchi B. Patel, MD
Prospective, Nonrandomized, 36-Month Study of Second-Generation Trabecular Microbypass Stents With Phacoemulsification in Eyes With Various Types of Glaucoma
Hengerer FH, Auffarth GU, Riffel C, Conrad-Hengerer I
Ophthalmol Ther. 2018;7:405-415
This prospective, nonrandomized, consecutive cohort study aimed to assess 36-month outcomes after cataract surgery and implantation of two second-generation trabecular microbypass stents (iStent inject) into eyes with various types of glaucoma.
Of the 81 eyes included, 60 had primary open-angle glaucoma (POAG), 15 pseudoexfoliative glaucoma (PEX), four appositional narrow-angle glaucoma, and one each pigmentary or neovascular (secondary) glaucoma. Data were reported as the proportion of eyes that achieved ≥ 20% intraocular pressure (IOP) reduction, IOP ≤ 18 mmHg, and IOP ≤ 15 mmHg, as well as the proportion of eyes achieving a reduction in the number of medications at month 36 vs the preoperative regimen. All subjects were Caucasian and had surgery with a single surgeon in Germany.
At baseline, 32.1% of eyes had undergone previous glaucoma surgery, 56% were receiving three to four preoperative medications, and one eye (1%) was medication-free. Mean preoperative IOP was 22.6 ± 6.2 mm Hg, and mean medication burden was 2.5 ± 1.1 medications. In a subgroup analysis of the preoperative data, patients with POAG were similar to the overall cohort, whereas those with PEX had about a 1 mm Hg higher IOP and a higher mean medication burden, at 2.8 medications. Of the original cohort, not all eyes were followed for the full 36 months. Therefore, some of the postoperative subgroup analyses were performed at 12 months’ follow-up.
Among the 41 eyes followed for 36 months, mean IOP decreased to 14.3 ± 1.7 (37% reduction), and mean medication burden to 0.8 ± 0.9 (68% reduction), compared with baseline. In addition, 78% of eyes achieved an IOP reduction of ≥20% from baseline, with 100% of eyes having IOP ≤ 18 mm Hg and 71% having ≤ 15 mmHg.
All patients had uncomplicated implantation of two stents after cataract extraction. No adverse events resulting from the stent were observed. Three patients underwent additional glaucoma surgery during the follow-up period because of increased IOP or progression of glaucoma unrelated to stent implantation….
Read more: https://www.medscape.com/viewarticle/909229