5-Year Efficacy And Safety Of Istent® Inject Combined With Phacoemulsification In Primary Open-Angle Glaucoma

To evaluate the efficacy and safety of phacoemulsification and iStent® inject implantation in primary open-angle glaucoma (POAG) at 5 years. 

In this retrospective multicenter study, we evaluated the reduction in intraocular pressure (IOP) and the number of topical anti-glaucoma medications at 5 years post-operatively in 71 patients who underwent combined phacoemulsification surgery and iStent® implantation for chronic open-angle glaucoma between January 2015 and December 2020.

Patients treated with topical anti-glaucoma medications and presenting with cataract who have undergone combined phacoemulsification and iStent® inject implantation with at least 5 years of follow-up were included. Pre and post-operative characteristics such as number of anti-glaucoma medications, intraocular pressure, best-corrected visual acuity, cup:disc ratio, were compared using paired sample t-tests. Data were collected at post-operative visits on day 1, day 7, month 1, month 12 and year 5 after surgery. 

Ninety-eight eyes of seventy-one patients were included in the study. Mean pre-operative IOP at baseline was 17.53 ± 3.86 mmHg (range 11-27 mmHg) with a mean of 1.83 ± 0.98 anti-glaucoma medications. At 12 months, mean medications reduction was 38% with a mean of 1.12 ± 1.07 anti-glaucoma medications. At 5 years, mean medications reduction was 18% with a mean of 1.5 ± 1.06 anti-glaucoma medications. Safety outcomes were favorable, with no case requiring filtering surgery.  

Combination of iStent® inject implantation and phacoemulsification produced durable reductions in IOP (12.5% reduction) and topical anti-glaucoma medications (18% reduction) over 5 years, while preventing the need for filtering surgery in this cohort of patients with a relative pre-operative disease burden.