Konopińska Joanna, Kozera Milena, Kraśnicki Paweł, Mariak Zofia, Rękas Marek
Department of Ophthalmology, Medical University of Białystok, M. Sklodowskiej-Curie 24A STR, 15-276 Białystok, Poland.
Department of Ophthalmology, Military Institute of Medicine, Szaserów 128 STR, 04-141 Warsaw, Poland.
J Ophthalmol. 2020 Jun 23;2020:8164703. doi: 10.1155/2020/8164703. eCollection 2020.
Evaluation of efficacy of the iStent trabecular bypass implant in reducing intraocular pressure (IOP) depending on the value pretreatment IOP and number of medications used before surgery in patients with primary open-angle glaucoma (POAG) and pseudoexfoliative glaucoma (PXG) and coexisting cataract.
A prospective, uncontrolled, interventional case series. 72 patients, on a mean age of 72.42 ± 9.17, were divided into two groups depending on baseline IOP: group I < 26 mmHg and group II ≥ 26 mmHg. All subjects underwent implantation of a single iStent together with cataract surgery. Best-corrected visual acuity (BCVA), IOP, number of antiglaucoma medications, visual field, and number and type of complications were examined before and after surgery. Postoperative patients were followed up at 1, 7, and 30 days and 3, 6, 12, and 24 months. All the patients were washed out preoperatively as well as postoperatively.
The mean observation time was 20 months. The mean preoperative IOP was 21.03 ± 1.44 mmHg in group I and reduced to mean 15.60 ± 2.12 mmHg after operation. In group II, mean IOP reduced from 26.00 ± 0.00 to 18.56 ± 1.81 (=0.003). Mean glaucoma medications decreased from 1.35 ± 0.65 to 0.29 ± 0.52 in group I ( < 0.001) and from 2.89 ± 1.18 to 1.33 ± 1.50 in group II ( < 0.001). At 24 months, medication reduction was significantly greater in group I than group II (=0.026).
Combined cataract surgery with implantation of iStent seems to be an effective procedure in patients with mild-to-moderate open-angle glaucoma and cataract. In patients with baseline IOP < 26 mmHg, surgery reduced IOP and medication use significantly declined to 2 years, with greater reductions achieved versus patients with baseline IOP ≥ 26 mmHg. This trial is registered with NCT03807869.
评估iStent小梁旁路植入术在降低原发性开角型青光眼（POAG）、假性剥脱性青光眼（PXG）及合并白内障患者眼压（IOP）方面的疗效，该疗效取决于术前眼压值及手术前使用的药物数量。
一项前瞻性、非对照、介入性病例系列研究。72例平均年龄为72.42±9.17岁的患者，根据基线眼压分为两组：I组眼压<26mmHg，II组眼压≥26mmHg。所有受试者均接受单枚iStent植入术及白内障手术。在手术前后检查最佳矫正视力（BCVA）、眼压、抗青光眼药物数量、视野以及并发症的数量和类型。术后患者在1天、7天、30天以及3个月、6个月、12个月和24个月进行随访。所有患者在术前及术后均进行洗脱期。
平均观察时间为20个月。I组术前平均眼压为21.03±1.44mmHg，术后降至平均15.60±2.12mmHg。在II组中，平均眼压从26.00±0.00降至18.56±1.81（P=0.003）。I组青光眼药物平均用量从1.35±0.65降至0.29±0.52（P<0.001），II组从2.89±1.18降至1.33±1.50（P<0.001）。在24个月时，I组的药物减少量显著大于II组（P=0.026）。
白内障手术联合iStent植入术似乎是治疗轻度至中度开角型青光眼合并白内障患者的有效方法。对于基线眼压<26mmHg的患者，手术降低了眼压，药物使用量在2年内显著下降，与基线眼压≥26mmHg的患者相比降幅更大。本试验已在NCT03807869注册。
