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Graefe's Archive for Clinical and Experimental Ophthalmology

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01-10-2021 | Glaucoma | Glaucoma

Comparison of 1-year surgical outcomes of combined cataract surgery and gonioscopy-assisted transluminal trabeculotomy (GATT) versus cataract surgery and iStent Inject

Authors: Hisham Hamze, Abhijit Anand Mohite, Pravin Pandey, Velota C. T. Sung, Imran Masood

Published in: Graefe's Archive for Clinical and Experimental Ophthalmology | Issue 10/2021

Abstract

Purpose

Evaluate the efficacy, safety, and complication rates of phacoemulsification cataract surgery when combined with either gonioscopy-assisted transluminal trabeculotomy (GATT) or iStent Inject.

Methods

This is a retrospective case-control study to compare the surgical outcomes of combined phacoemulsification cataract surgery with either GATT (phaco-GATT) or iStent Inject (phaco-iStent). Both groups had at least 1-year follow-up. The primary outcome measures were IOP and number of glaucoma medications (NGMs) at 1 year. Secondary outcomes measures were best corrected visual acuity (BCVA) and intra- or postoperative complications within the first year of follow-up. Success was defined as intraocular pressure (IOP) < 21 mmHg and ≥ 20% reduction in IOP at 1 year regardless of the NGM.

Results

Each group included 37 patients. The median baseline IOP (24 vs 17) and NGM (3 vs 2) were higher in the phaco-GATT group (p < 0.001). Phaco-GATT achieved a 38% (p < 0.0001) reduction in IOP compared to 13.2% (p < 0.001) in the phaco-iStent group at 1-year follow-up. The reduction in IOP and NGM was significantly higher in the phaco-GATT group (p < 0.01). After adjusting for baseline IOP, the reduction in IOP at 12 months was still significantly higher in the phaco-GATT group (p = 0.042). At 1 year, 86.4% of patients in the phaco-GATT group met the success criteria compared to 35.1% in the phaco-iStent group. Safety outcomes were slightly favourable in the phaco-iStent group.

Conclusion

Phaco-GATT and phaco-iStent showed a significant reduction in IOP and NGM, with phaco-GATT having a significantly higher reduction. Phaco-iStent appears to have a higher safety profile and is probably preferable in monocular patients and those with a high risk of bleeding.

Bar-David L, Blumenthal EZ (2018) Evolution of glaucoma surgery in the last 25 years. Rambam Maimonides Med J 9:e0024. https://doi.org/10.5041/rmmj.10345CrossRefPubMedCentral

Abu-Hassan DW, Acott TS, Kelley MJ (2014) The trabecular meshwork: a basic review of form and function. J Ocul Biol 2. https://doi.org/10.13188/2334-2838.1000017

Pillunat LE, Erb C, Jünemann AGM, Kimmich F (2017) Micro-invasive glaucoma surgery (MIGS): a review of surgical procedures using stents. Clin Ophthalmol 11:1583–1600CrossRef

Van Tassel SH, Chen D (2019) An update on microinvasive glaucoma surgery concurrent with cataract extraction. Curr Ophthalmol Rep 7:224–232CrossRef

Micro invasive glaucoma surgery by Glaukos. https://www.glaukos.com/healthcare-professionals/migs/. Accessed 16 Nov 2020

Craven ER, Katz LJ, Wells JM, Giamporcaro JE (2012) Cataract surgery with trabecular micro-bypass stent implantation in patients with mild-to-moderate open-angle glaucoma and cataract: two-year follow-up. J Cataract Refract Surg 38:1339–1345. https://doi.org/10.1016/j.jcrs.2012.03.025CrossRefPubMed

Spiegel D, Wetzel W, Neuhann T et al (2009) Coexistent primary open-angle glaucoma and cataract: Interim analysis of a trabecular micro-bypass stent and concurrent cataract surgery. Eur J Ophthalmol 19:393–399. https://doi.org/10.1177/112067210901900311CrossRefPubMed

Fea AM (2010) Phacoemulsification versus phacoemulsification with micro-bypass stent implantation in primary open-angle glaucoma. Randomized double-masked clinical trial. J Cataract Refract Surg 36:407–412. https://doi.org/10.1016/j.jcrs.2009.10.031CrossRefPubMed

Fea AM, Consolandi G, Zola M et al (2015) Micro-bypass implantation for primary open-angle glaucoma combined with phacoemulsification: 4-year follow-up. J Ophthalmol 2015. https://doi.org/10.1155/2015/795357

10.

Fernández-Barrientos Y, García-Feijoo J, Martínez-de-la-Casa JM et al (2010) Fluorophotometric study of the effect of the glaukos trabecular microbypass stent on aqueous humor dynamics. Investig Ophthalmol Vis Sci 51:3327–3332. https://doi.org/10.1167/iovs.09-3972CrossRef

11.

Samuelson TW, Katz LJ, Wells JM et al (2011) Randomized evaluation of the trabecular micro-bypass stent with phacoemulsification in patients with glaucoma and cataract. Ophthalmology 118:459–467. https://doi.org/10.1016/j.ophtha.2010.07.007CrossRefPubMed

12.

Arriola-Villalobos P, Martínez-de-la-Casa JM, Díaz-Valle D et al (2013) Mid-term evaluation of the new Glaukos iStent with phacoemulsification in coexistent open-angle glaucoma or ocular hypertension and cataract. Br J Ophthalmol 97:1250–1255. https://doi.org/10.1136/bjophthalmol-2012-302394CrossRefPubMed

13.

Belovay GW, Naqi A, Chan BJ et al (2012) Using multiple trabecular micro-bypass stents in cataract patients to treat open-angle glaucoma. J Cataract Refract Surg 38:1911–1917. https://doi.org/10.1016/j.jcrs.2012.07.017CrossRefPubMed

14.

Patel I, de Klerk TA, Au L (2013) Manchester iStent study: early results from a prospective UK case series. Clin Exp Ophthalmol 41:648–652. https://doi.org/10.1111/ceo.12098CrossRefPubMed

15.

Spiegel D, García-Feijoó J, García-Sánchez J, Lamielle H (2008) Coexistent primary open-angle glaucoma and cataract: preliminary analysis of treatment by cataract surgery and the iStent trabecular micro-bypass stent. Adv Ther 25:453–464. https://doi.org/10.1007/s12325-008-0062-6CrossRefPubMed

16.

Clement CI, Howes F, Ioannidis AS et al (2019) One-year outcomes following implantation of second-generation trabecular micro-bypass stents in conjunction with cataract surgery for various types of glaucoma or ocular hypertension: Multicenter, multi-surgeon study. Clin Ophthalmol 13:491–499. https://doi.org/10.2147/OPTH.S187272CrossRefPubMedPubMedCentral

17.

Neuhann R, Neuhann T (2020) Second-generation trabecular micro-bypass stent implantation: retrospective analysis after 12- and 24-month follow-up. Eye Vis 7. https://doi.org/10.1186/s40662-019-0169-7

18.

Hengerer FH, Auffarth GU, Riffel C, Conrad-Hengerer I (2018) Prospective, non-randomized, 36-month study of second-generation trabecular micro-bypass stents with phacoemulsification in eyes with various types of glaucoma. Ophthalmol Therapy 7:405–415. https://doi.org/10.1007/s40123-018-0152-8CrossRef

19.

Salimi A, Clement C, Shiu M, Harasymowycz P (2020) Second-generation trabecular micro-bypass (iStent inject) with cataract surgery in eyes with normal-tension glaucoma: one-year outcomes of a multi-centre study. Ophthalmol Therapy 9:585–596. https://doi.org/10.1007/s40123-020-00266-6CrossRef

20.

Ferguson TJ, Dockter Z, Bleeker A et al (2020) iStent inject trabecular microbypass stent implantation with cataract extraction in open-angle glaucoma: early clinical experience. Eye Vis 7. https://doi.org/10.1186/s40662-020-00194-3

21.

Salby AM, Skalicky SE (2020) Combined iStent® inject trabecular micro-bypass and phacoemulsification in Australian patients with open-angle glaucoma. Clin Ophthalmol 14:985–993. https://doi.org/10.2147/OPTH.S241628CrossRefPubMedPubMedCentral

22.

Guedes RAP, Gravina DM, Lake JC et al (2019) One-year comparative evaluation of iStent or iStent inject implantation combined with cataract surgery in a single center. Adv Ther 36:2797–2810. https://doi.org/10.1007/s12325-019-01067-5CrossRefPubMedPubMedCentral

23.

Popovic M, Campos-Moller X, Saheb H, Ahmed IIK (2018) Efficacy and adverse event profile of the iStent and iStent inject trabecular micro-bypass for open-angle glaucoma: a meta-analysis. J Curr Glaucoma Pract DVD 12:67–84. https://doi.org/10.5005/jp-journals-10008-1248CrossRef

24.

Manning D (2019) Real-world case series of iStent or iStent inject trabecular micro-bypass stents combined with cataract surgery. Ophthalmol Therapy 8:549–561. https://doi.org/10.1007/s40123-019-00208-xCrossRef

25.

Salimi A, Lapointe J, Harasymowycz P (2019) One-year outcomes of second-generation trabecular micro-bypass stents (iStent Inject) implantation with cataract surgery in different glaucoma subtypes and severities. Ophthalmol Therapy 8:563–575. https://doi.org/10.1007/s40123-019-00214-zCrossRef

26.

Guedes RAP, Gravina DM, Lake JC et al (2019) Intermediate results of iStent or iStent inject implantation combined with cataract surgery in a real-world setting: a longitudinal retrospective study. Ophthalmol Therapy 8:87–100. https://doi.org/10.1007/s40123-019-0166-xCrossRef

27.

Grover DS, Godfrey DG, Smith O et al (2014) Gonioscopy-assisted transluminal trabeculotomy, Ab interno trabeculotomy: technique report and preliminary results. Ophthalmology 121:855–861. https://doi.org/10.1016/j.ophtha.2013.11.001CrossRefPubMed

28.

Grover DS, Smith O, Fellman RL et al (2018) Gonioscopy-Assisted transluminal trabeculotomy: an ab interno circumferential trabeculotomy: 24 months follow-up. J Glaucoma 27:393–401. https://doi.org/10.1097/IJG.0000000000000956CrossRefPubMed

29.

Grover DS, Smith O, Fellman RL et al (2015) Gonioscopy assisted transluminal trabeculotomy: An ab interno circumferential trabeculotomy for the treatment of primary congenital glaucoma and juvenile open angle glaucoma. Br J Ophthalmol 99:1092–1096. https://doi.org/10.1136/bjophthalmol-2014-306269CrossRefPubMed

30.

Aktas Z, Ucgul AY, Bektas C, Sahin Karamert S (2019) Surgical outcomes of prolene gonioscopy-assisted transluminal trabeculotomy in patients with moderate to advanced open-angle glaucoma. J Glaucoma 28:884–888. https://doi.org/10.1097/IJG.0000000000001331CrossRefPubMed

31.

Rahmatnejad K, Pruzan NL, Amanullah S et al (2017) Surgical outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with open-angle glaucoma. J Glaucoma 26:1137–1143. https://doi.org/10.1097/IJG.0000000000000802CrossRefPubMed

32.

Grover DS, Godfrey DG, Smith O et al (2017) Outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) in eyes with prior incisional glaucoma surgery. J Glaucoma 26:41–45. https://doi.org/10.1097/IJG.0000000000000564CrossRefPubMed

33.

Boese EA, Shah M (2019) Gonioscopy-assisted transluminal trabeculotomy (GATT) is an effective procedure for steroid-induced glaucoma. In: Journal of Glaucoma. Lippincott Williams and Wilkins, pp 803–807

34.

Sharkawi E, Lindegger DJ, Artes PH et al (2020) Outcomes of gonioscopy-assisted transluminal trabeculotomy in pseudoexfoliative glaucoma: 24-month follow-up. Br J Ophthalmol. https://doi.org/10.1136/bjophthalmol-2020-315954

35.

Loayza-Gamboa W, Martel-Ramirez V, Inga-Condezo V et al (2020) Outcomes of combined prolene gonioscopy assisted transluminal trabeculotomy with phacoemulsification in open-angle glaucoma. Clin Ophthalmol 14:3009–3016. https://doi.org/10.2147/OPTH.S272298CrossRefPubMedPubMedCentral

36.

Baykara M, Poroy C, Erseven C (2019) Surgical outcomes of combined gonioscopy-assisted transluminal trabeculotomy and cataract surgery. Indian J Ophthalmol 67:505–508. https://doi.org/10.4103/ijo.IJO_1007_18CrossRefPubMedPubMedCentral

37.

Overview | Trabecular stent bypass microsurgery for open-angle glaucoma | Guidance | NICE. https://www.nice.org.uk/Guidance/IPG575. Accessed 11 Feb 2021

38.

Hodapp E, Parrish RK, Anderson DR (1993) Clinical decisions in glaucoma. Mosby

39.

Kerstetter JR, Brubaker RF, Wilson LJ, Kullerstrand LJ (1988) Prostaglandin F2α-1-isopropylester lowers intraocular pressure without decreasing aqueous humor flow. Am J Ophthalmol 105:30–34. https://doi.org/10.1016/0002-9394(88)90117-1CrossRefPubMed

40.

Shingleton BJ, Pasternack JJ, Hung JW, O’Donoghue MW (2006) Three and five year changes in intraocular pressures after clear corneal phacoemulsification in open angle glaucoma patients, glaucoma suspects, and normal patients. J Glaucoma 15:494–498. https://doi.org/10.1097/01.ijg.0000212294.31411.92CrossRefPubMed

41.

Poley BJ, Lindstrom RL, Samuelson TW (2008) Long-term effects of phacoemulsification with intraocular lens implantation in normotensive and ocular hypertensive eyes. J Cataract Refract Surg 34:735–742. https://doi.org/10.1016/j.jcrs.2007.12.045CrossRefPubMed

42.

Van Buskirk EM (1976) Changes in the facility of aqueous outflow induced by lens depression and intraocular pressure in excised human eyes. Am J Ophthalmol 82:736–740. https://doi.org/10.1016/0002-9394(76)90011-8CrossRefPubMed

43.

Shrivastava A, Singh K (2010) The effect of cataract extraction on intraocular pressure. Curr Opin Ophthalmol 21:118–122CrossRef

44.

iStent inject Trabecular Micro-Bypass System (Model G2-M-IS) – P170043 | FDA. https://www.fda.gov/medical-devices/recently-approved-devices/istent-inject-trabecular-micro-bypass-system-model-g2-m-p170043. Accessed 16 Nov 2020

45.

Sit AJ, McLaren JW (2011) Measurement of episcleral venous pressure. Exp Eye Res 93:291–298. https://doi.org/10.1016/j.exer.2011.05.003CrossRefPubMed

46.

Phelps CD, Armaly MF (1978) Measurement of episcleral venous pressure. Am J Ophthalmol 85:35–42. https://doi.org/10.1016/S0002-9394(14)76662-0CrossRefPubMed

47.

Battista SA, Lu Z, Hofmann S et al (2008) Reduction of the available area for aqueous humor outflow and increase in meshwork herniations into collector channels following acute IOP elevation in bovine eyes. Investig Ophthalmol Vis Sci 49:5346–5352. https://doi.org/10.1167/iovs.08-1707CrossRef

48.

Johnstone MA, Grant WM (1973) Pressure-dependent changes in structures of the aqueous outflow system of human and monkey eyes. Am J Ophthalmol 75:365–383. https://doi.org/10.1016/0002-9394(73)91145-8CrossRefPubMed

49.

Allingham RR, De Kater AW, Ethier CR (1996) Schlemm’s canal and primary open angle glaucoma: Correlation between Schlemm’s canal dimensions and outflow facility. Exp Eye Res 62:101–110. https://doi.org/10.1006/exer.1996.0012CrossRefPubMed

50.

Moses RA (1977) The effect of intraocular pressure on resistance to outflow. Surv Ophthalmol 22:88–100CrossRef

51.

Suson EB, Schultz RO (1969) Blood in Schlemm’s canal in glaucoma suspects: a study of the relationship between blood-filling pattern and outflow facility in ocular hypertension. Arch Ophthalmol 81:808–812. https://doi.org/10.1001/archopht.1969.00990010810010CrossRefPubMed

52.

Morphological changes in the distal outflow pathway of primary open angle glaucoma | IOVS | ARVO Journals. https://iovs.arvojournals.org/article.aspx?articleid=2333154. Accessed 18 Nov 2020

53.

Nesterov AP, Batmanov IE, Brikman VG (1978) State of the Schlemm’s canal at different levels of intraocular pressure. Vestn oftalmol:6–8

54.

Zhang X, Beckmann L, Miller DA et al (2020) In vivo imaging of Schlemm’s canal and limbal vascular network in mouse using visible-light OCT. Investig Ophthalmol Vis Sci 61. https://doi.org/10.1167/iovs.61.2.23

Title: Comparison of 1-year surgical outcomes of combined cataract surgery and gonioscopy-assisted transluminal trabeculotomy (GATT) versus cataract surgery and iStent Inject
Authors: Hisham Hamze
Abhijit Anand Mohite
Pravin Pandey
Velota C. T. Sung
Imran Masood
Publication date: 01-10-2021
Publisher: Springer Berlin Heidelberg
Keywords: Glaucoma
Trabeculotomy
Cataract
Published in: Graefe's Archive for Clinical and Experimental Ophthalmology / Issue 10/2021
Print ISSN: 0721-832X
Electronic ISSN: 1435-702X
DOI: https://doi.org/10.1007/s00417-021-05133-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Comparison of 1-year surgical outcomes of combined cataract surgery and gonioscopy-assisted transluminal trabeculotomy (GATT) versus cataract surgery and iStent Inject

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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