36-Month Outcomes Of Combined Phacoemulsification And Istent Inject Implantation In Asian Eyes With Normal Tension Glaucoma
Published 2026 - 44th Congress of the ESCRS
Reference: PP04.05 | Type: Free paper | DOI: 10.82333/yt9z-vq82
Authors: Dr Bryan Ang* 1 , Dr Bjorn Betzler 2 , Mr Zhong Han Chai 3 , Mr Lester Tey 4
1Ophthalmology,National Healthcare Group Eye Institute, Tan Tock Seng Hospital,Singapore,Singapore;Lee Kong Chian School of Medicine, Nanyang Technological University,Singapore,Singapore;Yong Loo Lin School of Medicine, National University of Singapore,Singapore,Singapore;Ophthalmology,Mayo Clinic,Jacksonville, Florida,United States, 2Ophthalmology,National Healthcare Group Eye Institute, Tan Tock Seng Hospital,Singapore,Singapore, 3Lee Kong Chian School of Medicine, Nanyang Technological University,Singapore,Singapore, 4Yong Loo Lin School of Medicine, National University of Singapore,Singapore,Singapore
Purpose
To evaluate 36-month outcomes of combined phacoemulsification and iStent inject implantation ("Phaco-iStent") in eyes with normal tension glaucoma (NTG).
Setting
Tertiary ophthalmology centre. A single-centre, multi-surgeon, retrospective study.
Methods
Data was collected from consecutive eyes of Asian subjects with NTG who underwent Phaco-iStent between 2018 and 2024. Primary outcomes were changes in intraocular pressure (IOP) and medication burden, and cumulative success probabilities from Kaplan-Meier (KM) analyses. KM analyses were performed with qualified success (QS), complete success (CS) and medication success (MS) criteria (decrease in ≥1 medication from baseline without an increase in IOP). Longitudinal changes were analysed using generalized estimating equations.
Results
Of 134 eyes with NTG which underwent Phaco-iStent surgery, 107 eyes completed 36 months of follow-up. At baseline, mean IOP was 13.6±2.8 mmHg and eyes were on a mean of 1.2±0.5 medications. Reductions in IOP and medications were observed at all timepoints, until 24 months (p≤0.05). At 36 months, medication use decreased by -0.8±0.0 (p<0.001) with no significant IOP reduction, proportion of medication-free eyes increased from 0% (n=0/134) at baseline to 76.6% (n=82/107), and 85.9% (92/107) of eyes had a medication reduction of ≥1 drop. Cumulative success probabilities at IOP thresholds of ≤15 / ≤12 mmHg showed significant increases (A-15[CS]: 86.1% vs 63.0%; A-12[CS]: 86.1% vs 26.9%, both p <0.001) when MS criteria was concurrently applied.
Conclusions
In Asian eyes with NTG, combined phacoemulsification and iStent inject implantation offers a role in sustained medication reduction and in achieving medication-free status, up to 36 months post-operatively.