Phaco, trabecular micro-bypass stents effective for primary angle-closure glaucoma
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Eyes with primary angle-closure glaucoma that underwent phacoemulsification and implantation of two trabecular micro-bypass stents experienced a significant reduction of IOP at 1 year compared with baseline, according to a study.
Currently, the primary treatment for primary angle-closure glaucoma involves phacoemulsification cataract surgery and laser peripheral iridotomy, which does not address the potential damage to the trabecular meshwork possibly caused by long-standing iridocorneal apposition and elevated IOP, study co-author Paul Harasymowycz, MD, told Ocular Surgery News.
“Compared to phacoemulsification alone, phacoemulsification with implantation of iStent or iStent inject yielded significantly greater reductions in intraocular pressure and medication use and was more protective against early postoperative intraocular pressure spikes. Thus, iStent and iStent inject could be viable options for treating patients with primary angle-closure glaucoma,” he said.
Reduction in IOP and medication
Harasymowycz and colleagues compared surgical outcomes of eyes that underwent cataract surgery and those that underwent cataract surgery combined with the implantation of iStent or iStent inject (both Glaukos). The retrospective matched cohort study examined postoperative change of mean IOP and medications at 1 year compared with baseline.
The study included 158 eyes with primary angle-closure glaucoma, of which 79 underwent phacoemulsification alone (phaco-only group) and 79 underwent phacoemulsification with implantation of two iStent or iStent inject devices (phaco-stent group). The average preoperative IOP was 16.8 mm Hg in the phaco-only group and 17.6 mm Hg in the phaco-stent group. The mean number of glaucoma medications was 1.8 in the phaco-only group and 2.2 in the phaco-stent group.
Both groups experienced significant reductions in IOP and glaucoma medication use at 1 year postoperatively. However, the phaco-stent group experienced a 4.7 mm Hg reduction in IOP from baseline compared with a 2.2 mm Hg reduction in IOP in the phaco-only group, a statistically significant difference (P < .001).
In the phaco-stent group, glaucoma medications significantly decreased by 46% to 1.2 medications compared with an 11% reduction to 1.6 medications in the phaco-only group, a statistically significant difference (P < .001).
“Lastly, combined cataract surgery with implantation of trabecular micro-bypass stents was protective against postoperative intraocular pressure spikes, as a significantly smaller proportion of eyes in the phaco-stent group experienced early postoperative intraocular pressure spikes of 4% compared to those in the phaco-only group of 18%,” Harasymowycz said.
Few complications
Posterior capsular opacification was observed in 16 eyes, nine in the phaco-only group and seven in the phaco-stent group. Rebound iritis occurred in four eyes, three in the phaco-only group and one in the phaco-stent group, all of which occurred within the first postoperative month. These were managed with topical steroids.
All eyes in the study successfully underwent phacoemulsification with or without implantation of two stents, and no evidence of intraoperative complications was observed. Postoperative adverse events were rare in either group.
There is little research available regarding the efficacy of trabecular micro-bypass stents in patients with primary angle-closure glaucoma, Harasymowycz said.
“The outcomes of our study shed light on a less commonly examined area of research, the implication of minimally invasive glaucoma surgery in angle-closure disease, and suggest that iStent and iStent inject could be viable options for treating these patients,” he said.
- For more information:
- Paul Harasymowycz, MD, can be reached at Department of Ophthalmology, University of Montreal, 4135 de Rouen, Montreal, QC, H1V 1G5, Canada; email: pavloh@igmtl.com.
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