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MIGS implantation of trabecular micro-bypass stent, cataract extraction, and endoscopic cyclophotocoagulation (ICE): review of surgical technique and postoperative findings

Poster Details

First Author: S.Sarkisian USA

Co Author(s):    N. Radcliffe   P. Parekh   R. Noecker        

Abstract Details



Purpose:

Intraocular pressure (IOP) reduction following micro-invasive glaucoma surgery (MIGS) with either trabecular micro-bypass stents or with endoscopic cyclophotocoagulation (ECP) in conjunction with cataract surgery has been shown in patients with open-angle glaucoma (OAG). The ICE surgical procedure is defined as a combined surgical technique to implantation of a trabecular micro-bypass stent (iStent) in conjunction with cataract extraction and ECP. This paper will summarize outcomes following ICE surgeries conducted by four surgeons.

Setting:

Surgeons in four private practice/university settings in the United States

Methods:

Phakic subjects with moderate OAG and cataract scheduled for cataract surgery were implanted with iStent (Glaukos, Laguna Hills, CA) and treated with ECP during cataract surgery via phacoemulsification by four surgeons. Evaluations included IOP, medication use, and assessment of complications and additional glaucoma surgeries.

Results:

Seventy subjects have been treated, including 34 subjects with previous glaucoma surgery. Forty-eight subjects have been followed for 3-6 months postoperatively. In this series, no operative complications occurred. At the preoperative exam, mean IOP was 19.4 (±5.5) mmHg, and 85.7% of subjects were on medications, including 58.6% of whom were taking 2 or more medications. In 48 of 70 eyes followed 3-6 months, mean IOP decreased to 15.8 (±3.1) mmHg. In these 48 eyes, 47.9% reported IOP reduction of 20% or greater, and 20.8% reported IOP reduction of 40% or greater. Over half of patients had IOP of ≤ 15 mmHg at the 3-6 month exam. Medication use at 3-6 months postoperative decreased such that 33.6% of subjects had discontinued medication, 39.6% were taking one medication and 26.8% were taking two or more medications. One patient noncompliant with medical therapy underwent trabeculectomy. One patient underwent iridotomy for stent obstruction. There were no reports of typical complications associated with filtration surgery; no incidence of hypotony

Conclusions:

Eyes with moderate glaucoma (49% with previous surgeries), experienced a reduction in IOP and medications through 3-6, and an excellent safety profile with no operative or postop complications typically seen with glaucoma surgeries. These data suggest the ICE procedure is promising low-risk therapy for eyes requiring more aggressive glaucoma treatment. FINANCIAL INTEREST: One of more of the authors... receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented, One of more of the authors... research is funded, fully or partially, by a competing company, One of more of the authors... research is funded, fully or partially, by a company producing, developing or supplying the product or procedure presented, One of more of the authors... receives consulting fees, retainer, or contract payments from a competing company

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