ESCRS - PO1027 - Three Year Retrospective Comparison Of Trabecular Micro-Bypass Stent Vs Excisional Goniotomy Combined With Cataract Surgery

Three Year Retrospective Comparison Of Trabecular Micro-Bypass Stent Vs Excisional Goniotomy Combined With Cataract Surgery

Published 2024 - 42nd Congress of the ESCRS

Reference: PO1027 | Type: Free paper | DOI: 10.82333/s96j-mf88

Authors: Kaitlyn Brettin* 1 , Mark F. Pyfer 1

1Wills Eye Hospital,Philadelphia,United States

Purpose

Minimally invasive glaucoma surgery (MIGS) combined with cataract extraction has
increased the surgical options for patients with mild-moderate glaucoma with visually
significant cataract. In the US, insurance reimbursement changes have decreased
access to trabecular micro-bypass stent (Glaukos Corp)
over the past 3 years, therefore excisional goniotomy (Kahook Dual Blade, KDB) was substituted for those
patients. We sought to determine the outcome of KDB goniotomy vs trabecular micro-
bypass stent combined with cataract surgery during this period.

Setting

Wills Eye Hospital, Philadelphia, PA, USA, and nearby private clinics and surgery
centers

Methods

We identified 336 eyes that underwent combined cataract surgery with iStent inject or
goniotomy with KDB, bent needle, Trabex (MicroSurgical Technology, Redmond,
Washington, USA), or SION (Sight Sciences, Menlo Park, California, USA). Intraocular
pressure (IOP) was recorded at the preoperative visit, and postoperatively at 1 day, 1
week, 2 weeks, 1 month, 3 months, 6 months, 9 months, 1 year, 1.5 years, 2 years, 2.5
years, and 3 years. Previous glaucoma interventions were noted. The number of IOP-
lowering agents was obtained preoperatively and at the longest follow-up visit.
Complications and secondary interventions were collected. Statistical analysis was
performed using t-tests to compare the 2 groups.

Results

115 eyes underwent goniotomy and 221 eyes underwent iStent inject. Average IOP reduction for POM6-11 was -2.21 for goniotomy (P=0.001) and –2.67 for iStent (P=0.001). There was no difference in average postoperative IOP between the goniotomy or iStent group at any time point postoperatively, though the difference was greatest at postop year 1 (P=0.08) and postop year 1.5 (P=0.07). There was no difference in the average number of IOP-lowering drops between the groups pre- or post-operatively. The number of IOP lowering agents was significantly reduced postoperatively in the iStent group (P=0.002). There was no difference in the odds of developing postoperative hyphema (P=0.064) or iritis (P=0.839) in cases of iStent compared to goniotomy.

Conclusions

Both goniotomy and iStent inject performed in combination with cataract surgery are
effective at reducing intraocular pressure, with demonstrated effect in this retrospective
study lasting through postoperative year 1 for goniotomy and postoperative year 2.5 for
iStent. Goniotomy and iStent lowered IOP to similar degree postoperatively; though at
year 1 and 1.5 postoperatively, iStent patients had lower IOP on average than
goniotomy patients at the same time point, with results approaching statistical
significance. IStent inject was more effective than goniotomy at lowering the number of
IOP-lowering agents required for patients postoperatively.