ESCRS - PP09.05 - Meta-Analysis Of Suprachoroidal Vs Trabecular Bypass Surgery As Standalone Treatment In Glaucoma With 24 Months Of Follow-Up

Meta-Analysis Of Suprachoroidal Vs Trabecular Bypass Surgery As Standalone Treatment In Glaucoma With 24 Months Of Follow-Up

Published 2024 - 42nd Congress of the ESCRS

Reference: PP09.05 | Type: Free paper | DOI: 10.82333/zwgg-be58

Authors: Burkhard Dick 1 , Jeremy Tan 2 , Ashish Agar 2 , Harsha Rao 3 , Kaweh Mansouri 4 , Julien Torbey* 5

1University Eye Hospital Bochum,Bochum,Germany, 2Faculty of Medicine and Health,University of New South Wales,Kensington,Australia;Department of Ophthalmology,Prince of Wales Hospital,Randwick,Australia, 3University Eye Clinic,University Medical Center,Maastricht,Netherlands;Narayana Nethralaya,Bangalore ,India, 4Glaucoma Department,University of Colorado Denver,Denver,United States;Swiss Visio Glaucoma Research Center,Montchoisi Clinic,Lausanne,Switzerland, 5Swiss Visio Glaucoma Research Center,Montchoisi Clinic,Lausanne,Switzerland

Purpose

This study compares the long-term intraocular pressure (IOP)-lowering efficacy of two minimally-invasive glaucoma surgery (MIGS) devices used in a standalone setting – the iStent® trabecular bypass device (Glaukos, CA, USA) and the MINIject® suprachoroidal device (iSTAR Medical, Belgium).

Setting

A systematic literature review and meta-analysis of standalone iStent and MINIject studies from a search of the PubMed, ScienceDirect, Cochrane Library, Embase and ClinicalTrials.gov databases was performed in March 2023 using the search terms “iStent”, “MINIject” and either “stand alone”, “standalone” or “stand-alone”.

Methods

Studies with IOP outcomes at 24-month follow-up or more were included. Internal data to supplement published data on MINIject was incorporated and cross-checked with later published data. iStent studies were only added where two stents were implanted. Mean and standard deviation of IOP and the number of anti-glaucoma medications preoperative and at the 24-month visit were collected. Weighted estimates were calculated using random-effects meta-analysis models. Results were presented using forest plots. Heterogeneity among the studies was quantified using I². Statistical analyses were performed using the Stata version 17.0 (StataCorp, College Station, TX, USA) statistical software.

Results

Seven studies (four iStent and three MINIject) comprising 282 eyes were meta-analysed. Mean baseline pre-operative IOP and IOP-lowering medications were 23.9mmHg and 2.4 in the MINIject trials, and 21.1mmHg and 2.7 in the iStent studies (p>0.05). At 24 months, reduction in both IOP (-9.57 vs -4.92mmHg, p=0.03) and medication use (-1.00 vs -0.56, p=0.26) was greater for MINIject vs iStent. The iStent studies displayed a greater variability in IOP reduction (I2=96.5%), with no heterogeneity for MINIject studies (I2=0%). The most frequent adverse events for MINIject were anterior chamber inflammation, BCVA loss, hyphema and conjunctival hemorrhage, and for iStent were device obstruction, BCVA loss, IOP spike and cataract progression.

Conclusions

While both devices resulted in a significant reduction in IOP and medication use, standalone MINIject implantation may provide a greater and more consistent reduction in IOP than implantation of two iStents.