Evaluation of a Trabecular Microbypass Stent With Cataract Extraction in Severe Primary Open-angle Glaucoma

Purpose:To evaluate the safety and efficacy of a trabecular microbypass stent combined with cataract surgery in patients with severe open-angle glaucoma.Patients:The series included 59 eyes with severe primary open-angle glaucoma and severe visual field loss as defined by American Academy of Ophthalmology preferred practice pattern criteria.Materials and Methods:Retrospective case series. Patients were implanted with 1 trabecular microbypass stent with concomitant cataract surgery. Primary outcome measures were intraocular pressure (IOP) and number of glaucoma medications. Safety measures included postoperative IOP pressure spikes 15mmHg or IOP<6mmHg at any time point, and the need for additional surgery.Results:The mean preoperative IOP was 19.256.97mmHg. Postoperatively, the mean IOP was 14.38 +/- 3.63mmHg (P<0.01) at 12 months and 14.92 +/- 3.86mmHg (P<0.01) at 24 months. The mean number of glaucoma medications was 2.27 +/- 1.06 preoperatively and 1.63 +/- 1.17 (P<0.01) at 24 months postoperative, indicating a 28% reduction in medication use. In total, 4 (7%) eyes required additional surgery. In total, 5 eyes (8%) experienced IOP spikes 15mmHg, 14 (24%) eyes had IOP spikes 10mmHg. Overall 55% of eyes had a 20% IOP reduction after 24 months of surgery. Eyes with baseline IOP19 had a mean reduction of 2.24mmHg 36 months after surgery.Conclusions:Trabecular microbypass stent implantation during cataract surgery safely and effectively lowers IOP and medication use in patients with severe primary open-angle glaucoma.