Long-term outcomes of two first-generation trabecular micro-bypass stents (iStent) with phacoemulsification in primary open-angle glaucoma: eight-year results.

Ali Salimi, Harrison Watt, Paul Harasymowycz
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引用次数: 11

Abstract

Background: The short- and medium-term outcomes of iStent have been extensively studied; however, only few studies have investigated its long-term outcomes. Here, we assessed the long-term efficacy and safety of two iStents with concomitant cataract surgery in glaucomatous eyes while also evaluating measures of disease stability using visual field and optical coherence tomography (OCT) of the optic nerve and the macula throughout 8 years of follow-up.

Methods: This longitudinal, single-center consecutive case series included glaucomatous eyes that underwent implantation of two first-generation trabecular micro-bypass stents (iStent) with concomitant cataract surgery. Eight-year efficacy outcomes included mean intraocular pressure (IOP) and medications, as well as surgical success. Eight-year safety outcomes included best-corrected visual acuity (BCVA), visual field mean deviation (VF-MD), cup-to-disc ratio (CDR), retinal nerve fiber layer (RNFL) thickness, ganglion cell-inner plexiform layer (GC-IPL) thickness, and adverse events.

Results: A total of 62 eyes with primary open-angle glaucoma (POAG) were included. At 8 years postoperative, IOP reduced by 26% from 19.2 ± 3.9 mmHg preoperatively to 14.2 ± 2.4 mmHg (P < 0.001), 91.1% of eyes achieved IOP ≤ 18 mmHg (vs. 51.6% preoperatively), 69.6% of eyes achieved IOP ≤ 15 mmHg (vs. 14.5% preoperatively), and 25% of eyes achieved IOP ≤ 12 mmHg (vs. 1.6% preoperatively). Medication use decreased by 17.9% from 2.8 ± 1.1 preoperatively to 2.3 ± 1.2 (P = 0.018). Surgical success was 90%, as six eyes underwent subsequent glaucoma surgeries. Safety measures of BCVA, CDR, RNFL thickness and GC-IPL thickness remained stable through 8 years postoperative. VF-MD remained stable until postoperative year 5 and subsequently progressed according to the natural history of glaucomatous disease.

Conclusions: Implantation of two iStents with concomitant cataract surgery is an effective and safe treatment option for surgery-naïve POAG eyes, evidenced by significant IOP and medication reductions, reasonable surgical success, and favorable safety outcomes, throughout the 8-year follow-up. Our data additionally supports the efficacy of this combined procedure in stabilizing or slowing disease progression.

Abstract Image

Abstract Image

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两个第一代小梁微搭桥支架(iStent)联合超声乳化术治疗原发性开角型青光眼的长期疗效:8年的结果
背景:iStent的短期和中期结果已被广泛研究;然而,只有少数研究调查了其长期效果。在这里,我们评估了两名伴有青光眼白内障手术的iStents的长期疗效和安全性,同时在8年的随访中,通过视神经和黄斑的视野和光学相干断层扫描(OCT)评估了疾病稳定性。方法:该纵向、单中心连续病例系列包括青光眼患者,他们接受了两个第一代小梁微搭桥支架(iStent)植入术,并伴有白内障手术。8年的疗效包括平均眼压(IOP)和药物,以及手术成功率。8年安全性指标包括最佳矫正视力(BCVA)、视野平均偏差(VF-MD)、杯盘比(CDR)、视网膜神经纤维层(RNFL)厚度、神经节细胞-内丛状层(GC-IPL)厚度和不良事件。结果:原发性开角型青光眼(POAG)共62眼。术后8年,IOP从术前的19.2±3.9 mmHg下降到14.2±2.4 mmHg,下降了26% (P结论:在8年的随访中,眼压和药物明显降低,手术成功率合理,安全性良好,植入两颗iStents合并白内障手术是surgery-naïve POAG眼的一种有效和安全的治疗选择。我们的数据还支持这种联合手术在稳定或减缓疾病进展方面的有效性。
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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