Comparing iStent versus CyPass with or without phacoemulsification in patients with glaucoma: a meta-analysis.

Area of Science:

• Ophthalmology
• Glaucoma Management
• Surgical Interventions

Background:

• Intraocular pressure (IOP) elevation is a primary risk factor for glaucoma progression.
• Minimally invasive glaucoma surgeries (MIGS) offer alternatives for IOP reduction.
• Comparing the efficacy of different MIGS devices is crucial for clinical decision-making.

Purpose of the Study:

• To perform a meta-analysis comparing the IOP-lowering effects of iStent and CyPass.
• To evaluate these effects when used as isolated procedures versus combined with cataract extraction.
• To determine the relative efficacy of different stent configurations and implantation types.

Main Methods:

• A meta-analysis was conducted using Cochrane review manager 5.3 software.
• Data from 33 publications were analyzed, comparing IOP and medication use across six groups.
• Groups were defined by stent type (iStent, CyPass), number of stents, and combination with cataract surgery.

Main Results:

• Both iStent and CyPass significantly reduced IOP, whether alone or with cataract surgery.
• Isolated CyPass implantation showed the largest mean IOP reduction (-8.96 ± 0.16 mmHg).
• Multiple iStent implantation without cataract surgery also demonstrated substantial IOP reduction (-7.48 ± 0.55 mmHg).

Conclusions:

• iStent and CyPass are effective in lowering IOP, both as standalone procedures and combined with cataract extraction.
• Isolated CyPass implantation yielded the most significant IOP reduction.
• The IOP-lowering effect was sustained for up to two years, with varying efficacy based on the device and surgical approach.