Comparison Between Phacoemulsification-iStent Inject W and Phacoemulsification-Micropulse Transscleral Laser Therapy...

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Medical Devices

Background:

• Open-angle glaucoma (OAG) and cataracts often coexist, requiring combined surgical approaches.
• Phacoemulsification with iStent Inject W and phacoemulsification with micropulse transscleral laser therapy (MPTLT) are surgical options for managing these conditions.
• Evaluating the comparative efficacy and safety of these combined procedures is crucial for clinical decision-making.

Purpose of the Study:

• To compare the 1-year efficacy and safety of phacoemulsification combined with iStent Inject W (phaco/iStent) versus phacoemulsification combined with micropulse transscleral laser therapy (phaco/MPTLT).

Main Methods:

• A retrospective cohort study included patients with mild-moderate OAG and cataract undergoing either phaco/iStent or phaco/MPTLT.
• Primary outcomes included 1-year cumulative probability of failure, defined by disease progression (OCT-RNFL, VFT), repeat surgery, or inability to maintain IOP below baseline/reduce medication.
• Secondary outcomes analyzed included postoperative intraocular pressure (IOP), medication use, visual acuity, and complications.

Main Results:

• Forty-six patients (23 per group) were analyzed. One-year cumulative failure probabilities were comparable: 52.20% for phaco/iStent and 47.80% for phaco/MPTLT (P=0.994).
• Mean 1-year postoperative IOP was similar between groups (15.57±2.95 mmHg vs. 14.39±2.25 mmHg; P=0.136).
• Both groups achieved significant medication reduction (P<0.05), and complication rates were similar. Phaco/MPTLT showed a statistically significant IOP reduction from baseline at 12 months (P=0.022).

Conclusions:

• Phacoemulsification combined with either iStent Inject W or micropulse transscleral laser therapy demonstrates comparable surgical efficacy and safety at 1 year.
• Both combined procedures effectively reduce the need for glaucoma medications.
• Micropulse transscleral laser therapy may offer sustained intraocular pressure reduction over the 1-year study period.