Cataract surgery with and without trabecular micro-bypass stent in primary angle-closure glaucoma: a multi-centre cohort study.

PURPOSE: To compare the effectiveness and safety of phacoemulsification with iStents (phaco-iStent) vs. phacoemulsification alone (phaco-alone) in primary angle-closure glaucoma (PACG).

METHODS

Retrospective, cohort, multi-centre study. The primary outcome was surgical success during follow-up, defining complete success(CS) as intraocular pressure(IOP) 6-18 mmHg without reoperations and ≥20% IOP reduction without medications, and qualified success(QS) as IOP 6-18 mmHg without reoperations and either ≥1medication reduction or ≥20% IOP reduction on the same medications. Secondary outcome measures were IOP reduction, number of glaucoma medications (nmeds), visual acuity (VA) and complications. Factors for failure were explored using Cox regression. Continuous variables were expressed as mean ± standard deviation.

RESULTS

One hundred and eighty-five eyes included, 90 phaco-alone and 95 phaco-iStent (mean age 77.7 ± 9.0 years, mean follow-up 24.6 ± 9.2 months). Whereas no differences were found in IOP reduction between groups, nmeds reduction was higher in phaco-iStent at month 1 (p = 0.006), 6 (p = 0.002), 12 (p = 0.005) and 24 (p = 0.02). CS was achieved in 13.8% phaco-iStent and 10.1% phaco-alone (p = 0.46), while QS was achieved in 54.3% and 62.0%, respectively (p = 0.30), with no differences in the survival function distributions. Cystoid macular oedema and anterior uveitis were reported in six phaco-iStent. There were no long-term sight-threatening complications or differences in postoperative VA change between groups.

CONCLUSION

Adding iStent to phacoemulsification may provide a modest reduction in glaucoma medications with similar IOP control than phacoemulsification alone in selected PACG patients. While generally safe, the risks of postoperative macular oedema and uveitis should be weighed against the benefit of reducing medication. Prospective, cost-effectiveness studies of iStent in PACG are warranted.