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Reduction in intraocular pressure and glaucoma drops after phaco plus in phakic eyes: one-year results

Poster Details

First Author: M.Pavel UK

Co Author(s):    A. Nagar   M. Nagar                 

Abstract Details


The primary aim of our study is to determine the reduction of Intraocular pressure (IOP) in phakic eyes after combined phacoemulsification with Intraocular lens implantation and ab-interno, gonioscopically guided implantation of two Glaukos iStent Injects in patients with coexisting cataract & primary open angle glaucoma (POAG). 53.06% patients were uncontrolled on glaucoma medications and 42.85% were non tolerant to glaucoma medications. The secondary aim of our study was to determine the reduction in glaucoma medications following iStent inject insertion.


Prospective, non-comparative, uncontrolled, non-randomised, interventional case series study in patients with uncontrolled mild or moderate open-angle glaucoma or advanced glaucoma with non-tolerance to most or all glaucoma drops in phakic eyes. Procedures performed by one surgeon (MN) at Pontefract General Hospital, Department of Ophthalmology, Mid Yorkshire Hospitals Trust, United Kingdom.


35 patients (45 eyes) with cataract and uncontrolled POAG underwent surgery. Mean group age was 76.10 years (55-90 years) and 51.02% were male and 30.61% female. All patients underwent uneventful phacoemulsification with IOL implant + iStent Inject. Postoperative follow-ups visits were planned at Day 1, Week 1 & months 1, 3, 6, 9 and 12. 24.48% of patients were on systemic Acetazolamide which was discontinued on the day of surgery and the remaining ocular hypotensive medications were gradually washed off during postoperative visits depending on the IOP.A Patient Satisfaction Survey was also conducted and results are quite promising.


Mean IOP reduction from baseline was 5.37 mmHg (23.35%) at Day 1, 33.92% at Month 6, 28.62% at Month 9 and 25.68% at Month 12. The number of ocular hypotensive medications were reduced from 2.55 drops at baseline to 1.5 at Month 1 and to 1.18 drops at Month 12 i.e. almost 50% reduction. Patients subjective view revealed in the Satisfaction Survey confirms our results disclosing a significant reduction in the number of drops and in the IOP (76.01% and 83.21% of patients, respectively) with minimal postoperative side effects. Most of them appreciated improved vision and reduction in glaucoma medication.


IOP reduction was clinically and statistically significant: mean IOP reduction of more than 25% at month 12 visit with 45% reduction in glaucoma drops. Implantation of iStent Inject at the time of cataract surgery may lead to better IOP control, reduce the need for glaucoma medications and hence better compliance. Microinvasive Glaucoma Surgery (MIGS) is gradually gaining popularity as a safe surgery. It is effective in reducing IOP and also glaucoma drops post operatively. Though long term follow-up and a larger patient group is required, the results seem to be encouraging thus far.

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