Ashley Porter1, Graham Lee1,2
Purpose: Investigate the outcomes of phacoemulsification with MIGS (iStent or Hydrus) for management of Open Angle Glaucoma (OAG).
Methods: A prospective comparative case series of phacoemulsification patients without OAG, with OAG, concurrent iStent insertion and concurrent Hydrus insertion. Endpoint outcomes included change in intraocular pressure (IOP) and number of glaucoma medications over one month.
Results: A total of 257 patients (M:F = 110:147) were included. On the first post-operative day, both phacoemulsification alone groups recorded a spike in IOP; those without OAG (n=148) by 2.6mmHg [95% CI:+1.5,+3.7] while those with OAG (n=41) by 5.2mmHg [95% CI:+2.4,+8.1]. The concurrent iStent insertion (n=39) reduced IOP by 2.7mmHg [95% CI:-5.6,+0.2] and the Hydrus (n=29) by 5.8mmHg [95% CI:-7.6,-4.1]. At one month, the phacoemulsification alone cases without OAG and with OAG both decreased the IOP by 1.3mmHg [95% CI:-2.0,+0.6] and 1mmHg [95% CI:-2.3,+0.3] respectively. The iStent group showed a reduction by 2.3mmHg [95% CI:-4.3,-0.3], and the Hydrus group by 3.0mmHg [95% CI:-4.8,-1.2]. In patients with OAG, the number of medications reduced by 0.2 [95% CI:-0.5,+0.1]. The iStent group resulted in a decrease by 0.6 [95% CI:-0.9,-0.3] and the Hydrus group by 1.4 medications [95% CI:-1.8,-0.7] at one month.
Conclusion: The day one post-phacoemulsification IOP spike often seen in OAG patients was reduced by the use of MIGS. At one month, the Hydrus group showed more IOP reduction than the iStent group (P value = 0.6) and a reduced number of medications (P value = 0.02).