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Phacoemulsification with Trabecular micro-bypass stents in complex and moderate to advanced glaucoma: 3 year outcomes

George Moussa, Pravin Pandey, Jesse Panthagani, Muhammad Kutubi, Imran Masood

Purpose: To evaluate longer-term (3 year) outcomes in terms of safety and efficacy of two trabecular micro-bypass stents implanted in combination with cataract surgery in patients with moderate to advanced and complex glaucoma.

Patients: Fifty consecutive patients with cataract and moderate to advanced primary glaucoma or significantly raised intra-ocular pressure or secondary glaucoma or those with a history of previously failed filtering surgery.

Methods: Retrospective, interventional case series. Patients underwent implantation of two trabecular micro-bypass stents in combination with cataract surgery. Outcomes measures included intra-ocular pressure (IOP), number of glaucoma medications, visual field mean deviation and need for secondary surgery. Results: The mean pre-operative IOP was 24.2 ± 7.3 mmHg, the mean post-operative IOP at 36 months (M36) was 16.2 ± 4.3 mmHg (p ≤ 0.05). This was a mean reduction of 8 mmHg (33.1%). Mean medication overall reduced from 3.2 preoperatively to 2.1 at M36 (p<0.05), a reduction of 34.4%. Visual field data was available for 30 eyes. There was no significant difference in mean MD over 36 months (p=0.267). Seven eyes (14%) required conversion to filtration surgery. No intraoperative complications were noted. Nine eyes (22.0%) were off medication at M36.

Conclusion: Trabecular micro-bypass implantation in combination with cataract surgery is a safe and effective option in patients with complex and advanced glaucoma and appears to stabilize visual fields.