7-Year Outcomes After Second-Generation Trabecular Micro-Bypass In Eyes With Or Without Prior Glaucoma Surgery

Fritz Hengerer

University of Heidelberg, Germany

Biography :

Fritz Hengerer completed his MD from Buerger hospital University and his PhD from University of Heidelberg. He is a professor and attending surgeon at the University Eye Hospital at the University of Heidelberg in Germany. He has published numerous papers in reputed journals and has been a guest presenter at over conferences.

Abstract :

Purpose: In Germany, 2nd-generation trabecular micro-bypass (iStent inject) can be im­planted with cataract surgery or as a standalone procedure. The current study evaluated combined and standalone outcomes in a single longitudinal cohort, stratified by whether eyes had undergone prior glaucoma surgery (No-Surg and Prior-Surg groups, respectively).

Methods: This prospective, non-randomized, unmasked study included 125 consecutive iStent inject cases of one surgeon at a large German academic hospital. There were 48 eyes (38% of cohort) with a total of 66 prior glaucoma surgeries, including predominantly trabeculecto­mies (18), cyclophotocoagulation (27), surgical iridectomy (6), and laser trabeculoplasty (7). Intraocular pressure (IOP), medications, adverse events, and secondary surgeries were as­sessed through 7 years in All-Eyes and in No-Surg (n=77) and Surg (n=48) subgroups.

Results: Preoperative mean IOP in All-Eyes was 23.5±6.2mmHg on 2.68±1.02 medications, re­ducing to 14.1±1.4mmHg on 1.09±0.66 medications at 7 years (40% and 59% reductions, re­spectively; both p<0.001). In No-Surg eyes, mean IOP decreased by 29% (22.2 to 15.8 mmHg, p<0.001) and medications by 61% (2.52 to 0.99, p<0.001). In Prior-Surg eyes, mean IOP de­creased by 46% (25.6 to 13.9 mmHg, p<0.001) and medications by 65% (2.92 to 1.02, p<0.001). At last follow-up, all eyes had the same or lower IOP and the same or lower medications vs preoperative. Seven eyes had a secondary glaucoma procedure (CPC or Xen); no eyes had filtering surgery.

Conclusions: iStent inject implantation with/without cataract surgery yielded significant, sus­tained, and safe 7-year IOP and medication reductions in eyes regardless of whether they had undergone prior glaucoma surgery.