Cataract Surgery With and Without MIGS Implant Lowers Medication Burden at 1 Year

Phacoemulsification plus endoscopic cyclophotocoagulation (ECP) with or without implantation of a trabecular micro-bypass device can significantly reduce intraocular pressure (IOP) among patients with open-angle glaucoma (OAG), according to an investigation published in International Ophthalmology. The techniques both can reduce the need for IOP-loweing medication at 1 year, the study shows.

A prospective, comparative, multicenter case series was conducted at 2 sites in Brazil with 71 patients with OAG undergoing cataract surgery. Patients were randomly assigned to receive phacoemulsification plus ECP alone (n=35; mean age, 66.2±9.3 years, 18 women, 17 men; 40% White) or with iStent Inject (Glaukos) implantation (n=36; mean age, 68.7±6.9 years; 21 women, 15 men; 33.3% White). The primary outcomes were the change in IOP and need for topical ocular hypotensive medication after surgery.

In the group that received the implant, 69.4% had primary OAG, 41.7% had moderate severe OAG, and patients took a mean 3.4±0.6 medications and had a mean preoperative IOP of 22.0±2.5 mm Hg. In the phaco/ECP alone group, 71.4% had primary OAG, and 51.4% had moderate severe OAG, patients took a mean 3.3±0.6 medications, and had a mean IOP of 22.1±3.6 mm Hg.

At the 1-month follow-up, IOP had decreased to 14.0 mm Hg among those in the phaco/ECP group, and 11.6 mm Hg among the implant group. By the 1-year follow-up, compared with baseline, the patients in the phaco/ECP group had an IOP reduction of 24.2%, to 16.2 mm Hg (P <.001) and the implant recipients had a 43.6% reduction, to 12.3 mm Hg (P <.001). At year 1, more of the implant recipients achieved IOPs of 18 mm Hg or lower (100% vs 97.0%) or 15 mm Hg or lower (100% vs 33.3%) compared with the phaco/ECP group.

At the 1-month follow-up, the number of hypotensive medications decreased to 0.4 among the phaco/ECP patientsand 0.3 among the implant group. At the 1-year follow-up, the number of medications used had decreased by 50.2% among the phaco/ECP patients, to 1.7 medications (P <.001) and by 71.5% among the implant group for a final number of 1.0 medications (P <.001).

At baseline, no eyes had a best-corrected visual acuity (BCVA) of 20/20 to 20/25. At year 1, 68.6% of patients in the phaco/ECP and 80.0% of those who received implants achieved BCVA of 20/20 to 20/25.

Among the phaco/ECP patients, 1 patient had a transitory bleeding event during the procedure and 1  had an IOP spike at postoperative day 1. Cell and flare events were observed up to month 1. Fixation loss occurred for 1 patient from month 1. For the implant group, 1 patient had a transitory bleeding event during the procedure and 1 patient had a stent over implantation. One hyphema event occurred during the first day following the procedure. Cell and flare events were observed up to week 1. Fixation loss occurred for 1 patient from month 1.

“These medication reductions represent significant benefits at the level of each patient, given the well-known personal, physical, social, and financial consequences of chronic medication exposure,” the study authors explain.

The major limitations of this study included the small sample size and short follow-up duration.