iStent with Phacoemulsification versus Phacoemulsification Alone for Patients with Glaucoma and Cataract: A
Monali S Malvankar-Mehta1, Yiannis Iordanous2, Yufeng Nancy Chen3
1Department of Ophthalmology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada.
Plos One
|July 7, 2015
Summary
Minimally invasive glaucoma surgery (MIGS) with iStent combined with phacoemulsification significantly lowers intraocular pressure (IOP) and reduces glaucoma medications more than phacoemulsification alone. This meta-analysis confirms iStent
Area of Science:
- Ophthalmology
- Surgical Innovation
- Glaucoma Management
Background:
- Minimally invasive glaucoma surgeries (MIGS) offer a promising approach to lower intraocular pressure (IOP) with an excellent safety profile.
- The iStent, a widely utilized MIGS device, has demonstrated potential benefits when used during phacoemulsification.
- Understanding the specific contribution of the iStent versus lens extraction to IOP reduction is crucial for glaucoma treatment paradigms.
Purpose of the Study:
- To systematically review and meta-analyze the IOP-lowering effects of iStent insertion during phacoemulsification compared to phacoemulsification alone.
- To evaluate the impact on topical glaucoma medication usage in both treatment groups.
Main Methods:
- A systematic review of databases was performed, including studies on iStent with phacoemulsification and phacoemulsification alone.
- Thirty-seven studies encompassing 2495 patients met the inclusion criteria.
- Intraocular pressure reduction (IOPR%) and medication reduction were analyzed using standardized mean difference (SMD) with fixed-effect and random-effect models.
Main Results:
- Phacoemulsification alone resulted in a 4% IOP reduction, while iStent with phacoemulsification yielded 9% (one iStent) and 27% (two iStents) reductions.
- iStent with phacoemulsification showed a significant IOP reduction compared to cataract extraction alone (SMD = -0.46).
- A significant decrease in glaucoma medications was observed with iStent combined with cataract extraction (SMD = -0.65) compared to cataract extraction alone.
Conclusions:
- Both iStent implantation with phacoemulsification and phacoemulsification alone effectively reduce IOP and medication dependence.
- The combination of iStent and phacoemulsification demonstrates superior IOP and medication reduction compared to phacoemulsification alone.
- This meta-analysis supports the use of iStent in conjunction with phacoemulsification for enhanced glaucoma management.
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