INITIAL SAFETY AND EFFICACY OF COMBINED ISTENT INJECT AND PHACOEMULSIFICATION IN MILD-MODERATE POAG.

To evaluate the efficacy and safety of combined phacoemulsification with iStent inject in patients with mild – moderate POAG. 

Ophthalmology Department, Cork University Hospital and South Infirmary Victoria University Hospital, Cork, Ireland

Retrospective analysis of patients diagnosed with Primary Open-Angle Glaucoma who underwent combined phacoemulsification and iStent inject. A total of 16 eyes were included in this audit. The primary focus was on assessing changes in intraocular pressure (IOP) and the number of topical anti-glaucoma agents used pre-operatively compared to 18 weeks post-operatively.

IOP Reduction: The combined phaco and iStent inject demonstrated a significant reduction in IOP from an average pre-operative level of 21.8 mmHg to an average of 13.68 mmHg at 18 weeks post-operatively. Medication Reduction: The average number of anti-glaucoma agents used pre-operatively was 2.81, which decreased to an average of 2.375 at 18 weeks post-operatively. Two patients encountered difficulties intraoperatively implanting the iStent into trabecular meshwork thus deemed unsuccessful. One patient had Trabeculectomy shortly after due to uncontrolled IOP (Data excluded). Two patients underwent Selective Laser Trabeculoplasty after 18 weeks to further lower IOP (Data included).

Based on the data presented, combined phacoemulsification and iStent implant appears to be effective in reducing intraocular pressure and decreasing the number of anti-glaucoma agents required for POAG management. In alignment with benchmarks set by contemporary randomized controlled trial, a ≥20% reduction in intraocular pressure (IOP) is considered a clinically meaningful metric for therapeutic efficacy. Applying the above criterion to our cohort, 75% achieved a ≥20% reduction in IOP reinforcing the significant clinical benefits of the combined procedure.