Combined Microinvasive Glaucoma Surgery – A Review of the Literature and Future Directions

Mai, Derek D; Ingram, Zoë; Oberfeld, Blake; Valle, David Solá-Del

doi:10.1080/08820538.2023.2181665

Cited by 5 publications

(11 citation statements)

References 27 publications

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“…PEcK, Phaco/ECP, and Phaco/KDB resulted in sustained reductions in IOP for more than 36 months, with magnitudes comparable to those reported in the other studies of patients with predominantly mild or moderate glaucoma. 1–4 , 6–17 The IOP reduction following each procedure was also associated with a simultaneous significant reduction in the medication burden. Despite being rarely reported, PEcK was associated in our study with a 12-month reduction in mean IOP of 3.8 mmHg on 1.1 fewer medications, which showed similar efficacy to that reported by Izquierdo et al and Klug et al The latter study suggested potentially greater efficacy of PEcK compared to ICE which had an associated 12-month reduction in mean IOP of 1.4 mmHg on 0.8 fewer medications.…”

Section: Discussionmentioning

confidence: 98%

“…Further, we demonstrate that patients who underwent PEcK, Phaco/ECP, or Phaco/KDB experienced significant reductions in both IOP and medication burden for more than 36 months, which is the first time that PEcK outcomes have been reported for more than 12 months postoperatively. 1 , 2 , 17 …”

Section: Discussionmentioning

confidence: 99%

“…With many different mechanisms of action among microinvasive glaucoma surgery (MIGS), there is a growing interest in establishing whether combining multiple MIGS (cMIGS) leads to an additive or synergistic effect. 1 Although a number of case reports, retrospective studies, and systematic reviews have reported on cMIGS, none has directly compared the combination procedure to all of its constituent MIGS. Despite this, understanding the relative efficacy of cMIGS to their constituent MIGS is fundamental to clinical decision making and to establishing the benefit of combination.…”

Section: Introductionmentioning

confidence: 99%

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Combined MIGS: Comparing Additive Effects of Phacoemulsification, Endocyclophotocoagulation, and Kahook Dual Blade

Oberfeld,

Golsoorat Pahlaviani,

Hall

et al. 2023

OPTH

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Purpose Combining two or more MIGS (cMIGS) promises to be more efficacious than single MIGS (sMIGS). This study compared the efficacy of PEcK, which combines Phacoemulsification (Phaco), Endocyclophotocoagulation (ECP), and Kahook dual blade (KDB), relative to both of its constituent sMIGS, Phaco/ECP (Endo Optiks, NJ) and Phaco/KDB (New World Medical, CA) for the first time. Patients and methods Data was collected retrospectively from 1833 visits of 271 patients who underwent PEcK, Phaco/ECP, or Phaco/KDB from 2016–2021 at Massachusetts Eye and Ear. Primary outcomes included Generalized Estimating Equations (GEE) of intraocular pressure (IOP) and medication burden, as well as survival models. Results Mean preoperative IOP was 17.6 ± 5.0 (SD) mmHg on 3.0 ± 1.4 medications in the PEcK group (n = 128), 17.9 ± 5.1 mmHg on 2.2 ± 1.5 medications in the Phaco/ECP group (n = 78), and 16.1 ± 4.3 mmHg on 0.4 ± 1.0 medications in the Phaco/KDB group (n = 65). For more than 36 months, all procedures resulted in significant patterns of IOP and medication reduction (all p < 0.001), before and after statistical adjustment. The reduction pattern in IOP was significantly different when comparing all groups over time and favored PEcK (p = 0.04), but the reduction pattern in medications was not significantly different (p = 0.11). Procedures did not differ in procedural time (p = 0.18) or in survival to maintain ≥20% IOP reduction (p = 0.43) without additional medication or procedure. There was a trend toward significant difference in maintaining IOP ≤ goal IOP that favored PEcK over Phaco/ECP after adjustment (p = 0.09). Conclusion PEcK may confer greater IOP reduction without added procedural time compared to Phaco/ECP and Phaco/KDB in predominantly mild or moderate glaucoma. Further research on cMIGS may benefit from adopting this comparative analysis to constituent MIGS.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Combined MIGS: Comparing Additive Effects of Phacoemulsification, Endocyclophotocoagulation, and Kahook Dual Blade

Oberfeld,

Golsoorat Pahlaviani,

Hall

et al. 2023

OPTH

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Section: Introductionmentioning

confidence: 99%

“…4 These combined MIGS (cMIGS) may result in more significant IOP and medication burden reduction than single MIGS (sMIGS), as suggested by some studies where cMIGS was more effective at reducing medication burden for at least 12 months. 5 When phacoemulsification is performed in combination with endocyclophotocoagulation (ECP), a procedure that decreases aqueous production, the addition of a second, outflow-enhancing MIGS procedure may augment the overall IOP-lowering effect. Prior research has demonstrated greater reduction in both IOP and medication burden in the combinations of phacoemulsification/ECP/Kahook Dual Blade trabecular excision (New World Medical, Rancho Cucamonga, CA) (PEcK) and phacoemulsification/ECP/iStent inject (Glaukos Corporation, San Clemente, CA) (ICE2) compared to phacoemulsification/ECP alone.…”

Section: Introductionmentioning

confidence: 99%

Comparing Outcomes of Phacoemulsification and Endocyclophotocoagulation with Either Dual Blade Goniotomy (PEcK) or Two Trabecular Stents (ICE2)

El Helwe,

Oberfeld,

Golsoorat Pahlaviani

et al. 2023

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Purpose To compare outcomes of phacoemulsification and endocyclophotocoagulation with either dual blade goniotomy (PEcK) or two trabecular stents (ICE2). Setting Retrospective, nonrandomized comparative study from a level 3 triage center. Methods One hundred and seventy charts and a total of 1294 visits were reviewed following either PEcK or ICE2 from 2018 to 2022. One hundred and twenty-eight patients had PEcK and 42 underwent ICE2. Patients with less than 30 days of follow-up were excluded. The mean follow-up time was 505 ± 308 days. Two Kaplan–Meier curves (KM) assessed survival with ≤ baseline medications while maintaining (1) [GIC – Goal IOP Criteria] IOP ≤ goal IOP or (2) [PRC – Percent Reduction Criteria] IOP reduction ≥ 20% with 5 mmHg ≤ IOP ≤ 21 mmHg for at least two consecutive visits. IOP and medication burden reduction were compared using a paired t -test. Results Most patients were Caucasian (65%) and had mild-stage glaucoma (43%). The most common glaucoma type was primary open-angle glaucoma (58%). Average age was 72.2 years at the time of surgery. Mean preoperative IOP was 17.58 ± 4.98 mmHg on 3.00 ± 1.41 medications in PEcK and 15.36 ± 3.58 mmHg on 1.81 ± 1.11 medications in ICE2 (p = 0.015 for IOP; p < 0.001 for medications). Under GIC, the success rate was significantly higher in PEcK at POM6 (69% vs 46%, p < 0.001) and POY1 (63% vs 36%, p < 0.001). Under PRC, the success rate was significantly higher in PEcK at POM6 (73% vs 61%, p = 0.031) and POY1 (67% vs 50%, p = 0.028). Mean reductions at POY1 were 5.00 ± 4.31 mmHg on 1.35 ± 1.08 less medications after PEcK and 3.14 ± 2.83 mmHg on 1.01 ± 0.94 less medications after ICE2 (p < 0.001 at POY1 for IOP; p < 0.05 after POW6 for medications). Conclusion Both PEcK and ICE2 reduce medication and IOP from baseline, with PEcK having more favorable GIC and PRC success rates and greater IOP and medication reduction at 1 year.

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Effectiveness and safety of istent inject as an interventional glaucoma approach for uncontrolled open-angle glaucoma

Vizzari,

Ceruti

2024

European Journal of Ophthalmology

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Introduction To describe the results of iStent inject implantation as a standalone procedure in early-stage uncontrolled glaucoma, with results up to 24 months. Methods A retrospective, single-center case series that recruited patients with open-angle glaucoma (OAG), uncontrolled IOP (defined as ≥18 mmHg), and who are receiving 1–4 glaucoma medications were implanted the iStent inject as a standalone procedure. Exclusion criteria were the contraindications of iStent inject implantation. Primary outcome measures were IOP at 6, 12, 18, and 24 months compared to baseline, and the number of medications at baseline and 24 months. Results Eighty-eight eyes from 88 patients, aged 57.6 ± 9.8 years, were included. Ten eyes underwent a subsequent glaucoma procedure during follow-up and were excluded from the analysis. The mean IOP (mmHg) was reduced from 20.54 ± 1.42 at baseline to 15.99 ± 1.98 and 16.15 ± 2.21 (n = 78, p < 0.001) at the 12- and 24-month follow-up, respectively, and the mean number of medications was reduced from 2.35 ± 0.70 to 1.31 ± 0.80 (p < 0.001) at 24 months. Of those eyes, 59% had ≥20% reduction in IOP at 24 months, 91% had an IOP ≤18 mmHg at 24 months, and 71.8% were receiving fewer medications. At 24 months, 14.1% of eyes were medication-free, compared to none at baseline. No serious intraoperative or postoperative adverse events occurred. Discussion iStent inject can effectively control intraocular pressure in mild glaucoma, reducing medication reliance and improving patient quality of life.

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Combined Microinvasive Glaucoma Surgery – A Review of the Literature and Future Directions

Cited by 5 publications

References 27 publications

Combined MIGS: Comparing Additive Effects of Phacoemulsification, Endocyclophotocoagulation, and Kahook Dual Blade

Combined MIGS: Comparing Additive Effects of Phacoemulsification, Endocyclophotocoagulation, and Kahook Dual Blade

Comparing Outcomes of Phacoemulsification and Endocyclophotocoagulation with Either Dual Blade Goniotomy (PEcK) or Two Trabecular Stents (ICE2)

Effectiveness and safety of istent inject as an interventional glaucoma approach for uncontrolled open-angle glaucoma

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