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Intraocular pressure reduction after combined phacoemulsification and iStent Inject in phakic eyes and standalone iStent Inject in pseudophakic eyes: preliminary 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 and primary open angle glaucoma (POAG) uncontrolled on glaucoma drops. The other group is POAG patients, with pseudophakia, uncontrolled on glaucoma drops who underwent iStent implantation. The secondary aim of our study was to determine the reduction in glaucoma medications in both groups.


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 and pseudophakic eyes. Procedures performed by one surgeon (MN) at Pinderfields Hospital, Department of Ophthalmology, Wakefield, UK.


Group 1: 19 eyes (16 patients) of which 63.16% male and 36.84% female with mean age 75.89 years with cataract and uncontrolled POAG. Group 2: 8 eyes (8 patients) of which 62.5% male and 37.5% female with mean age 77.87 years. Group 1 patients underwent phacoemulsification with IOL implant + iStent inject & Group 2 had Standalone iStent inject. Postoperative follow-ups at Day 1, Week 1 and months 1, 3, 6, 9 and 12. Acetazolamide discontinued on the day of surgery and the remaining ocular hypotensive medications were washed off at post operative visits depending on the IOP.


Group 1, mean IOP reduction from baseline was 5.41 mmHg (22.44%) at Day 1, increasing to 25.09% at Month 1 and 27.96% at Month 3. The Standalone iStent group demonstrated mean IOP reduction of 6.62 mmHg from baseline (26.97%) at Day 1 and 34.02% and 34.71% at Week 1 and Month 1 respectively. The number of ocular hypotensive medications were decreased in both groups (from 2.78 drops at baseline to 1.75 drops at Month 3 in Group 1 and from 2.62 drops at baseline to 1.75 drops at Month 3 in the standalone iStent group).


IOP reduction was clinically and statistically significant and both groups registered a reduction of more than 25% at month 3 visit with 37.05% 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 in both groups.

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