부산대학교 도서관

PRéCIS: Combining Trabectome or iStent with phacoemulsification equally reduces IOP and IOP-lowering medication burden during a 24-month follow-up, with a possible advantage to the Trabectome in the early postoperative period. PURPOSE:: Intra-subject same-surgeon comparison between phacoemulsification combined with Trabectome (Phaco/Trabectome) versus one 1st-generation iStent (Phaco/iStent). SETTINGS:: Private glaucoma and cataract practice. DESIGN:: Retrospective interventional case series. METHODS:: Data collected at 3-4 and 20-24 hours and up to 30 months following Phaco/Trabectome in one eye and Phaco/iStent in the contralateral eye in patients with bilateral visually-significant cataract and open-angle glaucoma. Evaluations included intra-ocular pressure (IOP), IOP-lowering medications (IOPmeds), visual acuity and complications. RESULTS:: Forty five patients (90 eyes) were identified (age 76.5, 57-95▒y). At 3-4 hours, IOP was above baseline in 12 and 13 eyes following Phaco/Trabectome and Phaco/iStent, respectively, but the degree of IOP elevation was smaller (P=0.048) following Phaco/Trabectome: 4.3▒mmHg, 2.0-6.6▒mmHg (95% CI) versus Phaco/iStent: 8.7▒mmHg, 3.8-13.6▒mmHg. At 20-24 hours, compared to baseline, IOP was significantly lower after Phaco/Trabectome (P=0.004) but not after Phaco/iStent (P=0.14) although the rate of hyphema was higher following Phaco/Trabectome (12/45 vs. 2/45 eyes, P=0.007). IOP reduction from baseline at 3-4 hours was significantly larger (P=0.020) in the 21 eyes with hyphema: (−3.9), (−6.4)-(−1.4) versus the 69 eyes without hyphema: (−0.3), (−2.0)-(+1.4). At 1, 6, 12 and 24 months, IOP and number of IOPmeds were similar and significantly lower compared to baseline following either procedure. No complications were encountered in either group. CONCLUSION:: Combined phacoemulsification with either Trabectome or 1st-generation iStent similarly lowers IOP and IOPmeds burden at 1, 6, 12 and 24 months following surgery. The Trabectome may have an advantage in lowering IOP faster and lessening the degree of IOP elevations in the early post-operative period.