Micro-Bypass Implantation for Primary Open-Angle Glaucoma Combined with Phacoemulsification: 4-Year Follow-Up

Antonio Maria Fea, Giulia Consolandi, Marta Zola, Giulia Pignata, Paola Cannizzo, Carlo Lavia, Teresa Rolle, Federico Maria Grignolo, Antonio Maria Fea, Giulia Consolandi, Marta Zola, Giulia Pignata, Paola Cannizzo, Carlo Lavia, Teresa Rolle, Federico Maria Grignolo

Abstract

Purpose. To report the long-term follow-up results in patients with cataract and primary open-angle glaucoma (POAG) randomly assigned to cataract surgery combined with micro-bypass stent implantation or phacoemulsification alone. Methods. 36 subjects with cataract and POAG were randomized in a 1 : 2 ratio to either iStent implantation and cataract surgery (combined group) or cataract surgery alone (control group). 24 subjects agreed to be evaluated again 48 months after surgery. Patients returned one month later for unmedicated washout assessment. Results. At the long-term follow-up visit we reported a mean IOP of 15,9 ± 2,3 mmHg in the iStent group and 17 ± 2,5 mmHg in the control group (p = NS). After washout, a 14,2% between group difference in favour of the combined group was statistically significant (p = 0,02) for mean IOP reduction. A significant reduction in the mean number of medications was observed in both groups compared to baseline values (p = 0,005 in the combined group and p = 0,01 in the control group). Conclusion. Patients in the combined group maintained low IOP levels after long-term follow-up. Cataract surgery alone showed a loss of efficacy in controlling IOP over time. Both treatments reduced the number of ocular hypotensive medications prescribed. This trial is registered with: NCT00847158.

Figures

Figure 1
Figure 1
Subject accountability: a total of 10 eyes in the combined group and 14 eyes in the control group had long-term follow-up data.
Figure 2
Figure 2
Mean intraocular pressure (IOP) at long-term follow-up before and after washout of ocular hypotensive medications at long-term follow-up (p values prior to and after washout: 0,14 in the combined group and 0,04 in the control group).

References

    1. Cedrone C., Mancino R., Ricci F., Cerulli A., Culasso F., Nucci C. The 12-year incidence of glaucoma and glaucoma-related visual field loss in Italy: the Ponza eye study. Journal of Glaucoma. 2012;21(1):1–6. doi: 10.1097/ijg.0b013e3182027796.
    1. Lau J. T. F., Lee V., Fan D., Lau M., Michon J. Knowledge about cataract, glaucoma, and age related macular degeneration in the Hong Kong Chinese population. British Journal of Ophthalmology. 2002;86(10):1080–1084. doi: 10.1136/bjo.86.10.1080.
    1. Friedman D. S., Jampel H. D., Lubomski L. H., et al. Surgical strategies for coexisting glaucoma and cataract: an evidence-based update. Ophthalmology. 2002;109(10):1902–1913. doi: 10.1016/s0161-6420(02)01267-8.
    1. Poley B. J., Lindstrom R. L., Samuelson T. W., Schulze R., Jr. Intraocular pressure reduction after phacoemulsification with intraocular lens implantation in glaucomatous and nonglaucomatous eyes. Evaluation of a causal relationship between the natural lens and open-angle glaucoma. Journal of Cataract and Refractive Surgery. 2009;35(11):1946–1955. doi: 10.1016/j.jcrs.2009.05.061.
    1. Shrivastava A., Singh K. The effect of cataract extraction on intraocular pressure. Current Opinion in Ophthalmology. 2010;21(2):118–122. doi: 10.1097/icu.0b013e3283360ac3.
    1. Fea A. M. Phacoemulsification versus phacoemulsification with micro-bypass stent implantation in primary open-angle glaucoma. Journal of Cataract and Refractive Surgery. 2010;36(3):407–412. doi: 10.1016/j.jcrs.2009.10.031.
    1. Samuelson T. W., Katz L. J., Wells J. M., Duh Y.-J., Giamporcaro J. E. Randomized evaluation of the trabecular micro-bypass stent with phacoemulsification in patients with glaucoma and cataract. Ophthalmology. 2011;118(3):459–467. doi: 10.1016/j.ophtha.2010.07.007.
    1. Spiegel D., Garcia-Feijoo J., Martinez de la Casa M. iStent trabecular micro-bypass and concurrent cataract surgery: 24 month results. Proceedings of the Annual Meeting of the Association for Research in Vision and Ophthalmology (ARVO '09); May 2009; Fort Lauderdale, Fla, USA.
    1. Craven E. R. Prospective randomized controlled trial of cataract surgery with trabecular micro-bypass stent in mild-moderate open angle glaucoma: safety in two-year follow-up. Proceedings of the American Society for Cataract and Refractive Surgery Annual Meeting (ASCRS '11); March 2011; San Diego, Calif, USA.
    1. Arriola-Villalòbos P., Martinez-de-la-Casa J. M., Dìaz-Valle D., Fernàndez-Pèrez C., Garcia-Sanchez J., Garcia-Feijoò J. Combined iStent trabecular micro-bypass stent implantation and phacoemulsification for coexistent open-angle glaucoma and cataract: a long-term study. British Journal of Ophthalmology. 2012;96(5):645–649. doi: 10.1136/bjophthalmol-2011-300218.
    1. Noecker R. J., Herrygers L. A., Anwaruddin R. Corneal and conjunctival changes caused by commonly used glaucoma medications. Cornea. 2004;23(5):490–496. doi: 10.1097/01.ico.0000116526.57227.82.
    1. Broadway D. C., Grierson I., O'Brien C., Hitchings R. A. Adverse effects of topical antiglaucoma medication. The outcome of filtration surgery. Archives of Ophthalmology. 1994;112(11):1446–1454. doi: 10.1001/archopht.1994.01090230060021.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다