Eyeworld

EW GLAUCOMA 66 November 2015 Husam Ansari, MD, highlighted the best glaucoma papers at the "Hot Off the Press" session at the 2015 ASCRS•ASOA Symposium & Congress. Here are the abstracts from the studies, with Dr. Ansari's comments regarding selection. Evaluation of trabecular micro-bypass stent with phacoemulsification in patients with open-angle glaucoma and cataract John P. Berdahl, MD, Tanner J. Ferguson, Justin A. Schweitzer, OD Purpose: To evaluate the safety and efficacy of the iStent Trabecular Micro-Bypass stent in combination with cataract surgery in patients with open-angle glaucoma. Methods: The series was comprised of 200 eyes with open-angle glau- coma. Data was collected preoper- atively, and postoperative data was collected at 1 day, 1 week, 1 month, 3 months, 6 months and 1 year, 18 months and 2 years. Data included intraocular pressure (IOP), number of glaucoma medications, visual acuity (VA), the incidence of postop- erative IOP pressure spikes of greater than ≥15 mm Hg at any time point, and need for additional surgery. Results: The mean preoperative IOP was 18.48±6.40 mm Hg. At 18 months postoperative, mean IOP was 14.90±3.64 mm Hg (p<0.001). The mean number of glaucoma medications was 1.27±1.01 preoper- atively and 0.69±1.06 (p<0.001) at 1 year postoperative. At 1 day postop- erative, 30 eyes (15%) experienced an IOP increase of 15 mm Hg above their baseline IOP that responded to topical therapy. One patient required additional surgery and was implanted with an Ahmed tube shunt postoperatively. Conclusion: The insertion of the iStent Trabecular Micro-Bypass stent in combination with cata- ract surgery effectively lowers IOP in open-angle glaucoma patients. Medication use was significantly reduced postoperatively. The safety profile appears favorable with a low rate of IOP spikes and only 1 patient requiring additional surgery. Dr. Ansari: Microinvasive glaucoma surgery (MIGS) continued to be the hottest glaucoma topic at this year's meeting. Multiple authors presented their clinical experiences with the iStent Trabecular Micro-Bypass stent (Glau- kos, Laguna Hills, Calif.). This study by John Berdahl, MD, and colleagues shows statistically significant reduction in IOP and need for glaucoma medica- tions in patients undergoing cataract surgery combined with iStent implan- tation. The authors also stratified their patients according to preoperative IOP and found that patients with the high- est preoperative IOP had the greatest IOP reduction 1 year after surgery. In- terestingly, this result was also noted in two other iStent studies presented at the meeting by Reay Brown, MD, and col- leagues and Michael Stiles, MD, and colleagues. Collectively, these studies confirm a generally favorable clinical outcome for patients undergoing iStent implantation with cataract surgery and suggest that patients with the highest IOP before surgery may benefit the most from the procedure. Prospective multicenter randomized comparison of phaco + Schlemm's canal microstent versus phaco alone for lowering IOP at 24 months Thomas W. Samuelson, MD Purpose: Compare the reduction of washed-out diurnal IOP and hypotensive medication due to a Schlemm's canal microstent in patients with open-angle glaucoma undergoing concurrent phacoemul- sification to phacoemulsification alone for 2 years after surgery. Methods: Prospective, controlled, randomized clinical study in Hot off the press: Scan to watch video! Fourth in a series of 5 presentations

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