Omni system, cataract surgery combination reduces IOP at 24 months
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Key takeaways:
- A study looked at real-world outcomes with Omni, Hydrus, iStent inject and cataract surgery.
- Patients treated with the Omni surgical system had the greatest reduction in IOP and medication use.
Patients with glaucoma who underwent cataract surgery in combination with the Omni surgical system had lower IOP and used fewer medications at 24 months compared with outcomes with other devices, according to a study.
Michael Mbagwu, MD, and colleagues conducted a retrospective study, published in the American Journal of Ophthalmology International, using real-world data from the IRIS Registry to explore three MIGS devices — Omni surgical system (Sight Sciences), Hydrus (Alcon) and iStent inject (Glaukos) — in combination with cataract surgery.
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“Given the widespread implementation of MIGS procedures and the potential impact to health care costs, understanding associated practice patterns, glaucoma patient profiles and long-term clinical outcomes is crucial,” the authors wrote. “A need therefore exists for studies evaluating the overall real-world evidence of effectiveness and safety of different MIGS techniques beyond 12 months.”
The study comprised 109,745 eyes of 77,391 patients; 428 patients were treated with Omni and cataract surgery, 1,435 patients were treated with Hydrus and cataract surgery, 4,769 patients were treated with iStent inject and cataract surgery, and 70,759 patients were treated with cataract surgery alone. Patients were stratified by their baseline IOP (greater than 18 mm Hg and 18 mm Hg or less), and IOP and medication use were assessed at 24 months.
Patients with higher baseline IOP who underwent an outflow procedure with the Omni system had a mean reduction in IOP of 6.64 mm Hg. The Hydrus group had a reduction of 5.71 mm Hg, the iStent inject group had a reduction of 4.96 mm Hg, and the cataract surgery alone group had a reduction of 5.55 mm Hg (all P < .001). There was a mean reduction of 1.34 medications in the Omni group, 1.2 medications in the Hydrus group, 0.86 medications in the iStent inject group and 0.67 medications in the cataract surgery alone group (all P < .001).
Patients with lower baseline IOP who underwent treatment with the Omni system had a mean reduction in IOP of 0.47 mm Hg, while the Hydrus group had an increase of 0.03 mm Hg, the iStent inject group had a reduction of 0.17 mm Hg, and the cataract surgery alone group had a reduction of 0.07 mm Hg. There was a mean reduction of 1.42 medications in the Omni group, 1.18 medications in the Hydrus group, 0.95 medications in the iStent inject group and 0.65 medications in the cataract surgery alone group (all P < .001).
Perspective
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While retrospective data have limitations, the remarkable volume of surgeries included in this analysis surely provides some useful information. It does appear as if the Omni procedure delivered the most significant IOP reduction and medication reduction in this cohort.
Because it is not practically feasible to perform a five-armed randomized prospective study, this may be some of the best comparative evidence between the different MIGS procedures that we will see. And most importantly, this study shows that all types of MIGS procedures do provide more significant IOP and medication reduction than cataract surgery alone and should encourage surgeons not currently performing MIGS procedures to consider adopting these techniques for the benefit of their patients with cataract and glaucoma.
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Mbagwu M, et al. Am J Ophthalmol Int. 2024;doi:10.1016/j.ajoint.2024.100015.
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