Abstract
Objective
To evaluate the outcomes of ab interno gelatin microstent implantation alone and in
combination with phacoemulsification for the reduction of intraocular pressure (IOP).
Design
Retrospective cohort study.
Participants
141 eyes of 141 patients with any glaucoma subtype, including refractory glaucoma,
operated in the Centre Hospitalier de l'Université de Montréal (CHUM) from 2015-2018.
Patients were included if they were over 40 years of age and had a preoperative IOP
of >18 mm Hg on maximum tolerated medical therapy.
Methods
All patients received ab-interno microstent implantation (XEN-45, Allergan, Madison,
NJ) with mitomycin C +/- combined phacoemulsification. The primary outcome was complete
surgical success (IOP 6-18 mm Hg and <20% reduction from baseline without IOP medications
or reoperations or cyclophotocoagulation); secondary outcomes included qualified success
allowing for medications, percentage reduction in mean IOP and medications, and reduction
in number of complications, interventions, and reoperations.
Results
Mean follow-up was 30.5 ± 10.2 months (±SD). Mean IOP was 23.3 ± 7.0 mm Hg on 3.4
± 0.8 medications at baseline and 13.3 ± 4.7 mm Hg on 1.9 ± 1.5 medications at 24
months of follow-up (p < 0.001). From 24-month survival analysis estimates, complete success was achieved
in 34.1% of microstent eyes versus 20.7% with combined phacoemulsification (p = 0.02); 79.1% versus 75.1% achieved qualified success, respectively (p = 0.86). Cases with combined phacoemulsification had a higher rate of failure (hazard
ratio [HR] = 1.6, 95% CI 1.1–2.3, p = 0.02). Needling with mitomycin-C or 5-fluorouracil postoperatively occurred in
54 eyes (38.3%). Complications included transient hypotony (10.6%), transient hyphema
(6.4%), macular edema (4.3%), and microstent exposure (2.8%). There were 33 eyes (23.4%)
with reoperations and 14 (9.9%) requiring subsequent cyclophotocoagulation lasers.
Conclusions
Microstent implantation required topical therapy in most cases 24 months following
surgery in primary and refractory glaucoma and, when combined with phacoemulsification,
had a higher risk of failure.
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Article Info
Publication History
Published online: March 23, 2022
Accepted:
February 12,
2022
Received in revised form:
January 26,
2022
Received:
October 7,
2021
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
