Comparison Between Phacoemulsification-iStent Inject W and Phacoemulsification-Micropulse Transscleral Laser Therapy in Asian Eyes With Mild-Moderate Open Angle Glaucoma.

Abstract

Prcis: In this retrospective cohort study, the 1-year cumulative probability of failure was comparable, achieving 52.20% in the phacoemulsification-iStent inject W (phaco/iStent) group and 47.80% in the phacoemulsification-micropulse transscleral laser therapy (phaco/MPTLT) group ( P =0.994).

Purpose: To compare the 1-year efficacy and safety of phacoemulsification combined with iStent Inject W (phaco/iStent) and phacoemulsification combined with micropulse transscleral laser therapy (phaco/MPTLT).

Methods: A retrospective cohort study that included patients with mild-moderate open angle glaucoma (OAG) and cataract who underwent either phaco/iStent or phaco/MPTLT in a tertiary hospital in Singapore between August 1, 2016 and December 31, 2022. The primary outcome measures were cumulative probabilities of failure between the 2 groups, with failure defined as disease progression by ocular coherence tomography (OCT-RNFL) or visual field test (VFT), repeat glaucoma surgery, and inability to maintain intraocular pressure (IOP) lower than preoperative baseline or the use of glaucoma medications for 2 consecutive visits after 1 month postoperatively. In addition, postoperative mean IOP, average number of IOP lowering medications, visual acuity, and complications were analyzed.

Results: Forty-six patients were included. Twenty-three eyes underwent phaco/iStent and 23 had phaco/MPTLT. The 2 groups had comparable cumulative probabilities of failure (52.20% phaco/iStent, 47.80% phaco/MPTLT; P =0.994) and mean IOP (15.57±2.95 mm Hg phaco /iStent, 14.39±2.25 mm Hg phaco/MPTLT; P =0.136) after 1 year. The change in IOP before surgery to 12 months is -1.04±3.07 mm Hg in the phaco/iStent group ( P =0.593) and -2.43±4.12 mm Hg in the phaco/MPTLT group ( P =0.022). Both achieved significant medication reduction burdens ( P <0.05). Intraoperative and postoperative complication rates were similar.

Conclusion: Both groups showed comparable surgical efficacy and safety after 1 year. The phaco/MPTLT group demonstrated sustained IOP reduction 1 year postoperatively.