Predictability of success for combined iStent inject trabecular bypass implantation with phacoemulsification in the subsequent eye

Clinical and Experimental Ophthalmology, vol. 51, pp. 437–445

Abstract

BACKGROUND: To investigate in combined iStent inject implantation with phacoemulsification carried out bilaterally, whether intraocular pressure (IOP)-lowering effectiveness in the first eye has a predictive potential for the outcome of the second eye in primary open-angle glaucoma (POAG). METHODS: This retrospective study included 72 eyes from 36 participants, who underwent trabecular bypass implantation in combination with cataract surgery at two study centres (Düsseldorf, Cologne). Surgery was classified as either 'success' or 'failure' based on three scores: IOP at follow-up <21 mmHg (Score A) or IOP < 18 mmHg (Score B), with an IOP reduction >20% respectively, without re-surgery and IOP ≤ 15 mmHg with an IOP reduction ≥40%, without re-surgery (Score C). RESULTS: The IOP lowering outcomes of first and second eyes did not differ significantly. There was a significantly higher chance of success in the second eye after effective surgery in the first eye compared with cases after a preceding failure. Within our cohort, a 76% probability of success for the subsequent eye was determined following prior success for Score A. This probability was reduced to 13% if surgery in the first eye failed. The respective probabilities were 75% and 13% for Score B and 40% and 7% for Score C. CONCLUSIONS: In bilateral trabecular bypass implantation combined with cataract surgery, there is a high predictive potential for subsequent eyes based on the extent of IOP-lowering in the initial eye, which should be considered by the surgeon for second eye surgeries.

Authors 7

1. David Kiessling
   Affiliation as printed

   Department of Ophthalmology St. Martinus‐Krankenhaus Düsseldorf Germany

2. Corinna Rennings
   Affiliation as printed

   Department of Ophthalmology St. Martinus‐Krankenhaus Düsseldorf Germany

3. Matthias Hild
   Affiliation as printed

   Department of Ophthalmology St. Martinus‐Krankenhaus Düsseldorf Germany

4. Alexandra Lappas

   University Hospital Cologne

   Affiliation as printed

   Department of Ophthalmology University Hospital of Cologne Cologne Germany

   Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany

5. Thomas Stefan Dietlein

   University Hospital Cologne

   Affiliation as printed

   Department of Ophthalmology University Hospital of Cologne Cologne Germany

   Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany

6. Gernot Franz Roessler Aachen Department of Ophthalmology

   RWTH Aachen University

   Affiliation as printed

   Department of Ophthalmology RWTH Aachen Aachen Germany

   Department of Ophthalmology St. Martinus‐Krankenhaus Düsseldorf Germany

   Department of Ophthalmology St. Martinus‐Krankenhaus Düsseldorf Germany

7. Randolf Alexander Widder corresponding

   University Hospital Cologne

   Affiliation as printed

   Department of Ophthalmology St. Martinus‐Krankenhaus Düsseldorf Germany

   Department of Ophthalmology University Hospital of Cologne Cologne Germany

   Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany