Matched Cohort Study of Cataract Surgery With and Without Trabecular Microbypass Stent Implantation in Primary Angle-Closure Glaucoma

PURPOSE: To compare 1-year outcomes of phacoemulsification alone (phaco-only) vs phacoemulsification with implantation of 2 trabecular microbypass stents (iStent or iStent inject; phaco-stent) in eyes with primary angleclosure glaucoma (PACG). DESIGN: Retrospective matched clinical cohort study. METHODS: PACG eyes that underwent phaco-only vs phaco-stent at a single ophthalmology center. Groups were matched for baseline intraocular pressure (IOP) and medication use with a tolerance of +/- 2 mm Hg and +/- 1 medication, respectively. Primary outcomes included postoperative change in the mean IOP and medications. One-year outcomes were assessed using generalized estimating equations corrected for baseline intergroup differences. RESULTS: One hundred fifty-eight eyes (79 per group) were included. At 1 year, IOP decreased by 13% (from 16.8 +/- 3.1 mm Hg preoperatively) in the phaco- only group (P <.001) and by 27% (from 17.6 +/- 3.2 mm Hg) in the phaco-stent group (P <.001). Medication use decreased by 11% (from 1.8 +/- 1.3 medications preoperatively) in the phaco-only group (P <.001) and by 46% (from 2.2 +/- 1.2 medications) in the phaco-stent group (P <.001). The phaco-stent group experienced significantly larger reductions in IOP and medications compared with the phaco-only group (P <.001). The incidence of IOP spikes was significantly greater in the phaco-only group (18%) compared with the phaco-stent group (4%; P = .005). Safety was favorable with few transient postoperative adverse events. CONCLUSION: The results of this study highlight that phacoemulsification with implantation of 2 trabecular microbypass stents is more effective and possibly more protective than phaco-only in PACG eyes, as evidenced by significantly larger IOP and medication reductions and smaller incidences of IOP spikes among the phacostent eyes. (C) 2021 Elsevier Inc. All rights reserved.