<p>Refractive Outcomes After Trabecular Micro-Bypass Stents (iStent <em>Inject</em>) with Cataract Extraction in Open-Angle Glaucoma</p>

Abstract

Purpose: Simultaneous cataract and glaucoma surgery has traditionally been challenging for the anterior segment surgeon. The introduction of minimally invasive glaucoma surgery (MIGS) in conjunction with cataract surgery appears safe and effective in lowering intraocular pressure. Although a significant visual impact leading from the combined procedure is unexpected, we aim to describe the refractive outcomes in a cohort of patients undergoing simultaneous cataract removal and iStent inject and discuss the potential implications of combined surgery in patients with co-existent glaucoma. Patients and Methods: This is a retrospective consecutive case series inclusive of patients undergoing combined femtosecond laser-assisted cataract surgery and the insertion of two trabecular micro-bypass stents (iStent inject). Visual acuity, refraction and astigmatic vector analysis were collated and analysed from the preoperative and 4 weeks postoperative visits. Results: One hundred and six eyes of 89 patients from 2 surgeons were included in the original cohort. The mean absolute difference from target refraction was 0.36 ± 0.25D. 73.9% of eyes were within ± 0.5D of the refractive target and 98.9% of eyes were within ± 1.00D. 73.8% of eyes had 0.5D or less residual refractive astigmatism following the procedure. Conclusion: We present a novel cohort of glaucoma patients undergoing combined trabecular micro-bypass stents (iStent inject) and cataract surgery achieving excellent refractive outcomes. The results of this study indicate that this second-generation device is refractively neutral.

<p>Quality of Life After Combined Cataract and Minimally Invasive Glaucoma Surgery in Glaucoma Patients</p>

“…18 Also, in 2020 a study result that iStent inject does not risk refractive outcomes and can be paired with cataract procedure safely. 19 In addition, most patients reported that there were no changes in their occupational, social and economic status following MIGS (85.2%, 59.8% and 98.8%) respectively. Since most of patients were over 60 years of age and retired, this may explain why their occupational life did not change and their economic status was not affected by changes in increased or decreased number of eye drops, as our institution provides free eye drops to all patients.…”

Clinical Outcomes After Second-Generation Trabecular Microbypass Stents (iStent inject®) with Phacoemulsification in Korean Patients

“…In summary, the results from previous studies and the present study demonstrated a significant reduction in medication use, and a significant proportion of patients ceased their medication after combination procedures [ 12 , 13 , 18 ]. These results are valuable in the context of disease progression, quality of life, secondary ocular surface disease, medication costs, and psychological aspects [ 9 , 10 , 15 , 23 ].…”

“…Scott et al reported 80% and 95% of eyes within 0.50 D and 1.00 D, respectively, after iStent® implant and cataract surgery [ 9 ]. Recently, Ioannidis et al reported that 73.8% of eyes had SEs ≤ 0.50 D and 98.9% of eyes had SEs ≤ 1.00 D [ 23 ]. The National Health Service data suggested a benchmark standard of 55% within 0.50 D and 85% within 1.00 D; 62.3% of patients within 0.50 D of the refractive target should represent a minimum level of efficiency following cataract surgery [ 27 , 28 ].…”

“…In addition, many studies with conventional glaucoma surgeries, such as trabeculectomy and glaucoma drainage device surgery, have shown decreased axial length, significant astigmatic changes, and increased refractive surprise [20][21][22]. Few studies, however, focused on refractive outcomes after phaco-combined surgery using iStentÒ or iStentÒ inject (combination group) [9,23].…”

<p>iStent Trabecular Micro-Bypass Stent Implantation with Cataract Surgery in a Japanese Glaucoma Population</p>

“…They have been studied extensively and are established as a safe and effective option in various types of OAG with and without concomitant cataract surgery. 7 – 40 However, relatively few studies have been completed in Japanese patients 11 , 23 or in NTG. 24 , 25 …”