3-Year Outcomes of iStent Implant Combined with Phacoemulsification in Asian Eyes with Glaucoma: A Multi-Dimensional Surgical Success Analysis.

Purpose

To evaluate the long-term performance of combined phacoemulsification and iStent implantation (iStent, iStent inject, and iStent inject W) in Asian patients with glaucoma and cataracts.

Patients and methods: This retrospective study included patients who underwent combined phacoemulsification and iStent implantation at a single tertiary center from November 2016 to July 2021. Eyes with varying glaucoma subtypes and severities were included. Changes in mean intraocular pressure (IOP) and the number of glaucoma medications were assessed at baseline and postoperative months (POM) 6, 12, 24, and 36. Surgical success was evaluated using multiple definitions, including complete and qualified success (CS/QS) criteria for IOP ≤18 and ≤15 mm Hg, modified success criteria (anyIOP, anyMed, or IOPMed), and the AAO-recommended criteria.

Results

A total of 284 eyes (mean age 70.8±8.9 y) had preoperative IOP of 15.8±3.9 mm Hg on 1.6±0.8 medications. At POM 36, mean IOP reduction was 1.4 mm Hg (P<0.001), and medication use decreased by 0.8 (P<0.001). CS and QS for IOP ≤18 mm Hg were 53.4% and 89.3%, respectively; for IOP ≤15 mm Hg were 41.2% and 63.5%, respectively. Success rates were 47.4% for anyMed, 55% for anyIOP, 42.2% for IOPMed, and 56.3% for the AAO criteria.

Conclusion

Combined iStent and phacoemulsification provided sustained, long-term reductions in both IOP and medication burden over 3 years, with over half achieving success across multiple stringent criteria, supporting its role as an effective, minimally invasive surgical option in real-world clinical practice.