Efficacy Of iStent Insertion Combined With Cataract Surgery For The ... [PDF]

Retrospective audit of patients undergoing combined phacoemulsification+ single iStent surgery over 12 month period from

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Mid Cheshire Hospitals NHS Foundation Trust

Efficacy Of iStent Insertion Combined With Cataract Surgery For The Management Of Glaucoma Rahul Dwivedi, Bhavani Karri & Dan Nguyen Mid-Cheshire Hospitals NHS Foundation Trust (U.K.) Introduction • Minimally invasive glaucoma surgery (MIGS) provides an alternative method of intraocular pressure (IOP) reduction with lower complication rate and shorter recovery time compared to conventional surgery.1

The iStent (Glaukos, Laguna Hills, California USA), a trabecular microbypass stent, is a MIGS device. 1mm heparin-coated, nonferromagnetic, surgical grade titanium stent with a rigid snorkel design.

• The iStent (Glaukos, Laguna Hills, California, USA) is one example of a MIGS device

Allows aqueous humour to directly drain from the AC into Schlemm’s canal by bypassing an obstructed trabecular meshwork.

• Our aim is to assess the efficacy and safety of iStents in lowering IOP in glaucoma patients at our hospital • We compare our results to standards set in a study used by the UK NICE IPG396 guidance document.2

A small corneal incision is made and viscoelastic is inserted into the anterior chamber.

Methods

Under gonioscopic guidance, using a special applicator, an L-shaped stent is slid through the trabecular meshwork + into Schlemm's canal.

• Retrospective audit of patients undergoing combined phacoemulsification+ single iStent surgery over 12 month period from March 2014–March 2015

Position of stent is verified, the viscoelastic is removed + the applicator withdrawn.

• Patient case notes/electronic records (Medisoft) reviewed. Information collected via proforma; analysed with Microsoft Excel • Variables assessed: • • • • • • • •

Mean IOP

Patient demographics Pre-operative IOP 3, 6 & 12 month post-operative IOP >20% IOP reduction at 12 months Number of pre + post-operative drops Pre-operative mean Visual Field (VF) deviation (HAP grading scale) Pre + post-operative visual acuity (VA) Intra + post-operative complications

Results • Sample = 53 eyes; mean age = 77 years • Variable glaucoma severity with overall sample mean pre-operative VF deviation = -10.16dB • • • • • • • •

Glaucoma Severity (HAP score)

Mild glaucoma (-12dB) = 39.58%. Mean pre-op IOP = 21mmHg (SD = 3.59) Mean Day 1 post-op IOP = 15.58mmHg (SD = 5.14) Mean 3 month post-op IOP = 15.15mmHg (SD = 3.59) Mean 6 month post-op IOP = 15.03mmHg (SD = 3.77) Mean 12 month post-op IOP = 15.03mmHg (SD = 3.37)

• At 12 months: • IOP < 21mmHg = 90.57% (48/53) • IOP

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