Efficacy and safety of combined cataract surgery with 2 trabecular microbypass stents versus ab interno trabeculotomy

PURPOSE: To compare the outcomes of combined cataract surgery with trabecular microbypass stents and ab inferno trabeculotomy in patients with open-angle glaucoma. SETTING: University of Toronto, Toronto, Ontario, and University of Montreal, Montreal, Quebec, Canada, and Glaucoma Associates of Texas, Dallas, Texas, USA. DESIGN: Retrospective case series. METHODS: Patients with primary open-angle, pseudoexfoliative, or pigmentary dispersion glaucoma were included. Primary outcome measures were intraocular pressure (IOP), postoperative medications, success (IOP <= 18 mm Hg, no glaucoma medications or reoperations), and postoperative adverse events. RESULTS: The average patient age was 76.5 years +/- 12 [SD]. Forty-nine eyes had phacoemulsification and 2 had stent implantations; 52 eyes had phacoemulsification and trabeculotomy surgery with a 12-month postoperative follow-up. The analysis of variance indicated a significant reduction in mean IOP from baseline to 12 months for stent (19.6 +/- 5.3 mm Hg to 14.3 +/- 3.1 mm Hg; P < .001) and trabeculotomy (20.6 +/- 6.8 mm Hg to 17.3 +/- 6.5 mm Hg; P < .001) and lower mean IOP at 12 months in the stent group (P = .01). The median number of glaucoma medications decreased from baseline to 12 months in both groups and was lower in the stent group at 3, 6, and 12 months. Thirty-nine percent (19 eyes) in the stent group and 14% (7 eyes) in the trabeculotomy group achieved success at 12 months (P = .006). The incidence of hyphema was lower in the stent group (P = .008). CONCLUSIONS: Both types of surgery achieved a significant reduction in IOP and medication use at 12 months, with the stent group achieving higher success and a reduced incidence of postoperative hyphema. (C) 2015 ASCRS and ESCRS