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

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Microsurgical Implants

Background:

• Primary angle-closure glaucoma (PACG) poses a significant risk to vision.
• Phacoemulsification is a common cataract surgery, often combined with glaucoma procedures.
• iStents are micro-invasive glaucoma devices aimed at improving aqueous humor outflow.

Purpose of the Study:

• To compare the efficacy and safety of phacoemulsification combined with iStents (phaco-iStent) versus phacoemulsification alone (phaco-alone).
• To evaluate outcomes in patients with primary angle-closure glaucoma (PACG).

Main Methods:

• Retrospective, multi-center cohort study involving 185 eyes.
• Primary outcome: surgical success defined by intraocular pressure (IOP) and medication reduction.
• Secondary outcomes: IOP reduction, medication count, visual acuity, and complications.

Main Results:

• No significant difference in IOP reduction between phaco-iStent and phaco-alone groups.
• Phaco-iStent group demonstrated a higher reduction in glaucoma medications at multiple time points.
• Similar rates of complete and qualified surgical success; no differences in visual acuity changes.
• Cystoid macular edema and anterior uveitis observed in six phaco-iStent cases.

Conclusions:

• Adding iStents to phacoemulsification may reduce medication burden in select PACG patients without compromising IOP control.
• Potential risks of macular edema and uveitis necessitate careful consideration against medication reduction benefits.
• Further prospective, cost-effectiveness studies on iStent use in PACG are recommended.