Back to Journals » Clinical Ophthalmology » Volume 13

Three-year outcomes of combined trabecular micro-bypass and phacoemulsification in a predominantly Hispanic population with primary open-angle glaucoma

Authors Gallardo MJ, Supnet RA

Received 28 September 2018

Accepted for publication 19 February 2019

Published 28 May 2019 Volume 2019:13 Pages 869—879


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Scott Fraser

Mark J Gallardo,1,2 Richard A Supnet1

1El Paso Eye Surgeons, PA, El Paso, TX, USA; 2Department of Ophthalmology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA

Purpose: To present long-term, real-world outcomes after implanting one trabecular micro-bypass stent with cataract surgery for primary open-angle glaucoma (POAG) in a predominantly Hispanic patient population.
Patients and methods: This retrospective, consecutive case series evaluated intraocular pressure (IOP), medications, and safety through 36 months after implanting one iStent®, during phacoemulsification cataract surgery. Eyes were stratified into 2 subgroups classified by preoperative IOP and surgical goal. The Controlled Group had IOP <18 mmHg on ≥1 medications, and goal to reduce medications. The Uncontrolled Group had IOP ≥18 mmHg and/or maximum tolerated medication load, and goal to reduce IOP. Assessments included IOP, medications, visual fields (VF), retinal nerve fiber layer thickness (RNFL), adverse events, and secondary surgeries.
Results: Of 168 total operated eyes, 87 eyes (49 Controlled, 38 Uncontrolled) completed 36 months of follow-up and comprise the Consistent Cohort in this report. At baseline, 79.6% (39/49) of Controlled eyes and 71.1% (27/38) of Uncontrolled eyes were from Hispanic patients. In the Controlled Group desiring medication reduction, mean medications were reduced by 77.3% (2.6 medications preoperatively vs 0.6 at 36 months; p<0.001. All Controlled eyes maintained or reduced medications versus preoperative; no eyes were on ≥3 medications (vs 61.2% preoperatively); and 58.3% were medication-free (vs 0% preoperatively). In the Uncontrolled Group desiring IOP reduction, mean IOP decreased by 31.2% (19.4 mmHg preoperatively vs 13.4 mmHg at 36 months; p<0.001), 91.7% of eyes achieved IOP ≤18 mmHg, 69.4% reached IOP ≤15 mmHg, and 77.8% decreased IOP ≥20% vs baseline. Uncontrolled eyes also experienced a 45.3% medication reduction (2.2 medications preoperatively vs 1.2 at 36 months; p<0.001). Favorable safety included no intraoperative complications, and stable VF and RNFL through 36 months.
Conclusion: In this predominantly Hispanic patient cohort, significant IOP and medication reductions were sustained safely through 36 months after iStent implantation during cataract surgery.

Keywords: glaucoma, trabecular micro-bypass, Hispanic, micro-invasive glaucoma surgery, IOP, long term, iStent®

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]