A Nonrandomized, Comparative Case Series of Combined Phacoemulsification with iStent Inject W and OMNI Surgical System.

PURPOSE

To compare efficacy and safety outcomes of phacoemulsification combined with either iStent inject W or OMNI surgical system with different degrees of gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with glaucoma.

DESIGN

Single-center, retrospective, nonrandomized comparative cohort study.

SUBJECTS

Consecutive cases that underwent phacoemulsification combined with either iStent inject W or OMNI surgical system with at least 12-month follow-up.

METHODS

Single-center retrospective comparative cohort study comparing outcomes between 3 groups: phacoemulsification with iStent inject W (phaco-iStent) or OMNI with either 90° to 180° (phaco-OG [OMNI and GATT]180) or >180° to 360° (phaco-OG360) of GATT.

MAIN OUTCOME MEASURES

Success at 12 months is defined as medication-free with either a 20% intraocular pressure (IOP) reduction or IOP ≤18 mmHg. Primary outcomes were IOP and the number of glaucoma medications. Secondary outcomes included complications and the need for further glaucoma surgery.

RESULTS

A total of 294 eyes (phaco-iStent, 135; phaco-OG180, 39; phaco-OG360, 120) of 250 patients were included with similar baseline IOP (18 mmHg, P = 0.91) and medications (2.04 vs. 1.67 vs. 2.01, P = 0.22) across groups. Significant reductions in IOP and number of glaucoma medications were observed across all 3 groups (P < 0.0014), although no significant differences were found between procedures for any outcome measure. Success rates were 25.2%, 38.5%, and 32.5%, whereas medication-free rates were 28.1%, 38.5%, and 35.0% for the phaco-iStent, phaco-OG180, and phaco-OG360 groups, respectively, without significant differences. Phaco-OG360 achieved significantly higher rates of medication-free IOP reductions of ≥30% compared with phaco-iStent (P = 0.013) in exploratory analysis. Complications were more frequent in the phaco-OG180 and phaco-OG360 groups compared with the phaco-iStent group, with higher rates of microhyphema (5.1% and 10.8% vs. 0.7%) and layered hyphema (12.8% and 4.2% vs. 0.7%), respectively. One eye in the phaco-OG360 group underwent a trabeculectomy at 6 months.

CONCLUSIONS

All procedures significantly reduced IOP and medication burden, with no significant difference in overall success rates. Phaco-iStent has a better safety profile, although phaco-OMNI may provide higher rates of medication-free IOP reduction. Outcomes between 180° and 360° of GATT were similar, suggesting limited additional benefit from extending trabeculotomy. These findings may help guide decision-making in combined phacoemulsification and canal-based minimally invasive glaucoma surgery. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.