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. 2019 Jul 25:13:1331-1340.
doi: 10.2147/OPTH.S206619. eCollection 2019.

Refractive outcomes after trabecular microbypass stent with cataract extraction in open-angle glaucoma

Rachel A Scott  1 , Tanner J Ferguson  2 , John D Stephens  3 , John P Berdahl  3
Affiliations

Refractive outcomes after trabecular microbypass stent with cataract extraction in open-angle glaucoma

Rachel A Scott et al. Clin Ophthalmol. .

Abstract

Purpose: To evaluate the impact of trabecular microbypass stents combined with cataract surgery on refractive outcomes in patients with open-angle glaucoma (OAG).

Setting: Private practice, Sioux Falls, South Dakota, USA.

Design: Retrospective, comparative case series.

Methods: Eyes with OAG had implantation of trabecular microbypass stents with concomitant cataract surgery. The unmatched control group comprised eyes that underwent only cataract extraction. Data were collected preoperatively and postoperatively for 6 months. Data included spherical equivalent (SE), astigmatic error, intraocular pressure (IOP), and number of glaucoma medications.

Results: The series included 76 consecutive OAG eyes with combined cataract plus trabecular microbypass stent and 50 consecutive non-OAG eyes with cataract surgery only. SE outcomes were equivalent between the groups (P<0.001). For the combined and cataract-only groups respectively, 46% vs 52% had SEs within 0.25 D of the target, 80% vs 80% within 0.50 D, and 95% vs 94% within 1.00 D. Astigmatism outcomes did not significantly differ between the groups (P>0.05). As for magnitude of astigmatism in the combined and cataract only groups respectively, 51% vs 32% were within 0.5 D, 75% vs 66% within 1.0 D, 87% vs 82% within 1.5 D, and 89% vs 94% within 2.0 D. In the OAG combined-surgery group, mean intraocular pressure reduction was 3.4 mmHg (P<0.0001) at 1 month postoperatively, 4.0 mmHg (P<0.0001) at 3 months, and 3.4 mmHg (P<0.01) at 6 months. Mean decrease in number of glaucoma medications was 0.4 (P<0.05) at 1 month, 0.7 (p<0.0001) at 3 months, and 0.9 (P<0.001) at 6 months.

Conclusion: The results of this study suggest the trabecular microbypass stent is a refractively neutral device.

Keywords: MIGS; cataract surgery; glaucoma; outcomes; refractive.

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Conflict of interest statement

This study was supported by an investigator-initiated trial grant from Glaukos Corp (San Clemente, CA). Drs. Berdahl and Ferguson are consultants for Glaukos. Additionally, Dr. Berdahl is a lecturer and consultant for Alcon and Allergan. He is a consultant for Avedro, Aurea Medical, Bausch and Lomb, Dakota Lions Eye Bank, Gore, Johnson and Johnson, Kala, Kedalion, MELT Pharmaceuticals, MicroOptx, New World Medical, Imprimis, Ocular Theraputix, Orasis, Oyster Point, RxSight, Tear Clear, Vittamed, Zeiss, Vance Thompson Vision, Surface Inc, Omega Ophthalmic, Ocular Surgical Data, Expert Opinion, CorneaGen, and Visionary Ventures. In addition, he reports ownership with Zeiss, Vance Thompson Vision, Surface Inc, Verana Health, Omega Ophthalmic, Ocular Surgical Data, Expert Opinion, and CorneaGen; he is also a patent holder for Imprimis. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Difference between spherical equivalent outcome and target. Notes: Ratio of cases with spherical equivalent outcome within a certain number of designated diopters of target spherical equivalent. Blue bars represent cataract-only cases. Orange bars represent cases of cataract surgery with trabecular microbypass stent. TOST equivalence testing showed the spherical outcomes of the two groups were equivalent (t124=4.5, P<0.0001). Abbreviation: TOST, two one-sided test.
Figure 2
Figure 2
Magnitude of preoperative corneal astigmatism and postoperative refractive astigmatism in patients with combined cataract surgery with trabecular microbypass stent.
Figure 3
Figure 3
Magnitude of preoperative corneal astigmatism and postoperative refractive astigmatism in patients with cataract surgery only.
Figure 4
Figure 4
Double-angle plot showing preoperative and postoperative astigmatic vectors and their means and spread for the combined cataract surgery with trabecular microbypass–stent group.
Figure 5
Figure 5
Double-angle plot showing preoperative and postoperative astigmatic vectors and their means and spread for the cataract surgery–only group.
Figure 6
Figure 6
Distribution of different lens types (monofocal, multifocal, and toric) for the combined-surgery group and the cataract-only group.
Figure 7
Figure 7
Mean intraocular pressure (IOP) and number of glaucoma medications from baseline to 6 months postoperatively in eyes implanted with a trabecular microbypass stent during cataract surgery. Note: Error bars represent SD.
See this image and copyright information in PMC

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