The Short-Term Efficacy and Safety of iStent Implantation Combined With Cataract Extraction on Lowering The Intraocular Pressure in Patients with Glaucoma: A Pilot Study in Indonesia
Abstract
Introduction: Minimally invasive glaucoma surgery (MIGS) is continuously being improved after it was first initiated in the early 2000s. This promising method is hoped to fill the gap between medication and traditional surgeries in management of glaucoma.
Objective: To evaluate the efficacy and safety of iStents implantation combined with cataract extraction in managing intraocular pressure in glaucoma patients.
Methods: We collected data from 6 eyes of 5 patients with POAG and cataract pre-operatively. The extraction of cataract was then performed, combined with second generation iStents implantation. The follow up procedure included the change of intra ocular pressure (IOP), Visual acuity, and the need for IOP lowering Medication at 1 week and 1 month post-operatively.
Results: There was a reduction of mean IOP from the baseline, which was 21.33 ± 6.15 to 18.0 ± 6.0 and 18.11 ± 5.57 at 1-week and 1-month following the surgery. The reduction of IOP was also followed by the reduction of medications needed for the patients. The mean visual acuity following the surgery was also increased from the baseline 0.53 ± 0.41 to 0.85 ± 0.17 at 1 – week and 0.91 ± 0.16 at 1 – month. For safety outcomes, there were no major adverse effect nor complication from the procedures after 1 month of follow up.
Conclusion: The iStents implantation helped lowering the IOP of patients with glaucoma. It also reduced the need for further IOP lowering medication following the procedure.
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References
Fingeret, M. and Dickerson, J. (2018). The Role of Minimally Invasive Glaucoma Surgery Devices in the Management of Glaucoma. Optometry and Vision Science, 95(2), pp.155-162.
Coleman A, Richter G. Minimally invasive glaucoma surgery: current status and future prospects. Clinical Ophthalmology. 2016;:189.
Pillunat L, Erb C, Jünemann A, Kimmich F. Micro-invasive glaucoma surgery (MIGS): a review of surgical procedures using stents. Clinical Ophthalmology. 2017;Volume 11:1583-1600.
Varma R, Lee P, Goldberg I, Kotak S. An Assessment of the Health and Economic Burdens of Glaucoma. 2019.
Beckers H, Schouten J, Webers C, van der Valk R, Hendrikse F. Side effects of commonly used glaucoma medications: comparison of tolerability, chance of discontinuation, and patient satisfaction. Graefe's Archive for Clinical and Experimental Ophthalmology. 2008;246(10):1485-1490.
Myers J, Masood I, Hornbeak D, Belda J, Auffarth G, Jünemann A et al. Prospective Evaluation of Two iStent® Trabecular Stents, One iStent Supra® Suprachoroidal Stent, and Postoperative Prostaglandin in Refractory Glaucoma: 4-year Outcomes. Advances in Therapy. 2018;35(3):395-407.
Resende A, Patel N, Waisbourd M, Katz L. iStent® Trabecular Microbypass Stent: An Update. Journal of Ophthalmology. 2016;2016:1-9.
Guedes R, Gravina D, Lake J, Guedes V, Chaoubah A. Intermediate Results of iStent or iStent inject Implantation Combined with Cataract Surgery in a Real-World Setting: A Longitudinal Retrospective Study. Ophthalmology and Therapy. 2019;8(1):87-100.
Rulli E, Biagioli E, Riva I, Gambirasio G, De Simone I, Floriani I et al. Efficacy and Safety of Trabeculectomy vs Nonpenetrating Surgical Procedures. JAMA Ophthalmology. 2013;131(12):1573.
Jiang L, Eaves S, Dhillon N, Ranjit P. Postoperative outcomes following trabeculectomy and nonpenetrating surgical procedures: a 5-year longitudinal study. Clinical Ophthalmology. 2018;Volume 12:995-1002.
Murdoch I. Post-operative management of trabeculectomy in the first three months. Community Eye Health. 2012;25(79-80):73–75.
Wellik S, Dale E. A review of the iStent® trabecular micro-bypass stent: safety and efficacy. Clinical Ophthalmology. 2015;:677.
Popovic M, Campos-Moller X, Saheb H, Ahmed IIK. Efficacy and Adverse Event Profile of the iStent and iStent Inject Trabecular Micro-bypass for Open-angle Glaucoma: A Meta-analysis. J Curr Glaucoma Pract. 2018;12(2):67–84. doi:10.5005/jp-journals-10008-1248
Malvankar-Mehta M, Iordanous Y, Chen Y, Wang W, Patel S, Costella J et al. iStent with Phacoemulsification versus Phacoemulsification Alone for Patients with Glaucoma and Cataract: A Meta-Analysis. PLOS ONE. 2015;10(7):e0131770.
Nemesure B. Corneal Thickness and Intraocular Pressure in the Barbados Eye Studies. Archives of Ophthalmology. 2003;121(2):240.
Stodtmeister R, Kron M, Gaus W. IOP measurement and central corneal thickness. Br J Ophthalmol. 2002;86(1):120–121.
Iordanous Y, Kent JS, Hutnik CML, Malvankar-Mehta MS. Projected cost comparison of Trabectome, iStent, and endoscopic cyclophotocoagulation versus glaucoma medication in the Ontario Health Insurance Plan. J Glaucoma. 2014;23:e112–118. [PubMed] [Google Scholar] [Ref list]
Carreon T, van der Merwe E, Fellman R, Johnstone M, Bhattacharya S. Aqueous outflow - A continuum from trabecular meshwork to episcleral veins. Progress in Retinal and Eye Research. 2017;57:108-133.
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