A Nonrandomized, Comparative Case Series of Combined Phacoemulsification with iStent Inject W and OMNI Surgical System

IF 3.3 Q1 OPHTHALMOLOGY

Ophthalmology. Glaucoma Pub Date : 2026-05-01 Epub Date: 2025-11-29 DOI:10.1016/j.ogla.2025.11.005

Ethan Wen Wei Tiong MBChB , Aysha Salam MBBS , Navanandhanan Pradeesh MBChB , Imran Masood MBBS

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Abstract

Purpose

To compare efficacy and safety outcomes of phacoemulsification combined with either iStent inject W or OMNI surgical system with different degrees of gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with glaucoma.

Design

Single-center, retrospective, nonrandomized comparative cohort study.

Subjects

Consecutive cases that underwent phacoemulsification combined with either iStent inject W or OMNI surgical system with at least 12-month follow-up.

Methods

Single-center retrospective comparative cohort study comparing outcomes between 3 groups: phacoemulsification with iStent inject W (phaco-iStent) or OMNI with either 90° to 180° (phaco-OG [OMNI and GATT]180) or >180° to 360° (phaco-OG360) of GATT.

Main Outcome Measures

Success at 12 months is defined as medication-free with either a 20% intraocular pressure (IOP) reduction or IOP ≤18 mmHg. Primary outcomes were IOP and the number of glaucoma medications. Secondary outcomes included complications and the need for further glaucoma surgery.

Results

A total of 294 eyes (phaco-iStent, 135; phaco-OG180, 39; phaco-OG360, 120) of 250 patients were included with similar baseline IOP (18 mmHg, P = 0.91) and medications (2.04 vs. 1.67 vs. 2.01, P = 0.22) across groups. Significant reductions in IOP and number of glaucoma medications were observed across all 3 groups (P < 0.0014), although no significant differences were found between procedures for any outcome measure. Success rates were 25.2%, 38.5%, and 32.5%, whereas medication-free rates were 28.1%, 38.5%, and 35.0% for the phaco-iStent, phaco-OG180, and phaco-OG360 groups, respectively, without significant differences. Phaco-OG360 achieved significantly higher rates of medication-free IOP reductions of ≥30% compared with phaco-iStent (P = 0.013) in exploratory analysis. Complications were more frequent in the phaco-OG180 and phaco-OG360 groups compared with the phaco-iStent group, with higher rates of microhyphema (5.1% and 10.8% vs. 0.7%) and layered hyphema (12.8% and 4.2% vs. 0.7%), respectively. One eye in the phaco-OG360 group underwent a trabeculectomy at 6 months.

Conclusions

All procedures significantly reduced IOP and medication burden, with no significant difference in overall success rates. Phaco-iStent has a better safety profile, although phaco-OMNI may provide higher rates of medication-free IOP reduction. Outcomes between 180° and 360° of GATT were similar, suggesting limited additional benefit from extending trabeculotomy. These findings may help guide decision-making in combined phacoemulsification and canal-based minimally invasive glaucoma surgery.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

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一个非随机的，比较病例系列联合超声乳化术与iStent注射W和OMNI手术系统。

目的：比较超声乳化术联合iStent注射W或OMNI手术系统联合不同程度的腔镜辅助下小梁切开术（GATT）治疗青光眼患者的疗效和安全性。设计：单中心、回顾性、非随机对照队列研究。对象：连续行超声乳化术联合静脉注射W或OMNI手术系统的病例，随访至少12个月。方法：单中心回顾性比较队列研究，比较三组超声乳化术的结果：使用iStent注射W （phaco-iStent）或使用90°-180°（phaco-OG (OMNI和GATT)180°）或>180°-360°（phaco-OG360） GATT的OMNI。主要结局指标：12个月的成功定义为无药物治疗，眼压（IOP）降低20%或IOP≤18mmhg。主要结局是IOP和青光眼药物的数量。次要结果包括并发症和需要进一步青光眼手术。结果：250例患者中有294只眼（phaco-iStent， 135只；phaco-OG180, 39只；phaco-OG360, 120只），各组的基线IOP （18 mmHg, p = 0.91）和药物（2.04 vs 1.67 vs 2.01, p = 0.22）相似。三组患者的IOP和青光眼药物数量均显著降低（p < 0.0014），但在任何结果测量中，不同治疗方法之间均未发现显著差异。phaco-iStent组、phaco-OG180组和phaco-OG360组的成功率分别为25.2%、38.5%和32.5%，无药率分别为28.1%、38.5%和35.0%，差异无统计学意义。在探索性分析中，Phaco-OG360的无药IOP降低率显著高于phaco-iStent，≥30% （p = 0.013）。与phaco-iStent组相比，phaco-OG180组和phaco-OG360组的并发症发生率更高，微水肿发生率（5.0%和10.8%）和层状水肿发生率（12.8%和4.2%）分别高于phaco-iStent组。phaco-OG360组的一只眼在6个月时接受了小梁切除术。结论：所有手术均可显著降低眼压和药物负担，总体成功率无显著差异。Phaco-iStent具有更好的安全性，尽管phaco-OMNI可能提供更高的无药IOP降低率。180°和360°GATT的结果相似，表明延长小梁切开术的额外益处有限。这些发现可能有助于指导超声乳化联合微创青光眼手术的决策。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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