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Colin Clement, 1– 4 Frank Howes, 5 Alexandros S Ioannidis, 6 Michael Shiu, 7 David Manning, 8 Jed Lusthaus, 3, 4, 9 Ridia Lim, 3, 10 Simon E Skalicky, 11 Todd Goodwin 12 1Eye Associates, Sydney, NSW, Australia; 2Fairfield Eye Surgery, Fairfield, NSW, Australia; 3Glaucoma Unit, Sydney Eye Hospital, Sydney, NSW, Australia; 4Discipline of Ophthalmology, The University of Sydney, Sydney, NSW, Australia; 5Eye & Laser Centre, Gold Coast, QLD, Australia; 6Vision Eye Institute, Melbourne, VIC, Australia; 7Laser Sight Centre, Melbourne, VIC, Australia; 8Hunter Cataract & Eye Centre, Charlestown, NSW, Australia; 9Eyehaus, Sydney, NSW, Australia; 10Hunter St. Eye Specialists, Parramatta, NSW, Australia; 11Department of Surgery Ophthalmology, University of Melbourne, Melbourne, VIC, Australia; 12NQ Eye Specialists, Currajong, QLD, AustraliaCorrespondence: Colin ClementEye Associates, Level 4, 187 Macquarie Street, Sydney, NSW 2000, AustraliaTel +612 9247 9972Email colinandkylie@me.comPurpose: This multicenter study evaluated 2-year effectiveness and safety following implantation of two second-generation trabecular micro-bypass stents (iStent inject®) with phacoemulsification.Materials and Methods: This was a retrospective study of iStent inject implantation with phacoemulsification by nine surgeons across Australia. Eyes had mild to advanced glaucoma (predominantly primary open-angle/POAG, appositional angle-closure/ACG, or normal-tension/NTG) or ocular hypertension (OHT), and cataract. Evaluations included intraocular pressure (IOP); medications; proportions of eyes with 0 or ≥ 2 medications, reduced/stable medications versus preoperative, and IOP ≤ 15 mmHg; visual acuity; cup-to-disc ratio (CDR); visual fields (VF); adverse events; and secondary surgery.Results: A total of 340 eyes underwent surgery and had 24-month follow-up data. At 24 months, mean IOP decreased by 16% from 16.4± 4.7 mmHg preoperatively to 13.7± 3.1 mmHg (p< 0.001), and 77% of eyes achieved IOP of ≤ 15 mmHg versus 49% preoperatively (p< 0.001). Mean number of medications decreased by 67% to 0.49± 0.95 versus 1.49± 1.20 preoperatively (p< 0.001), with 74% of eyes medication-free versus 25% preoperatively (p< 0.001), and 14% of eyes on ≥ 2 medications versus 46% preoperatively (p< 0.001). Medication burden was reduced or stable in 98% of eyes versus preoperative. Stratified analyses showed significant IOP and medication reductions across glaucoma subtypes (POAG, ACG, NTG, OHT): 13– 22% for IOP (p< 0.01 for all) and 62– 100% for medication (p< 0.001 for all). Favorable safety included few adverse events; stable CDR, VF, and visual acuity; and filtering surgery in only 8 eyes (2.4%) over 2 years.Conclusion: This 340-eye multicenter dataset provides robust evidence of the safety and efficacy of iStent inject implantation with phacoemulsification, with significant and sustained IOP and medication reductions through 2 years. Results were similarly favorable across glaucoma subtypes (including POAG, ACG, NTG, OHT) and were attained across various glaucoma severities, clinical sites, and surgeons, highlighting the real-world versatility and utility of this treatment modality.Keywords: microinvasive glaucoma surgery, MIGS, glaucoma, iStent inject, intraocular pressure, second-generation, multicenter

Alon M Salby,1 Simon E Skalicky1,2 1Department of Ophthalmology, Royal Melbourne Hospital, Melbourne, VIC, Australia; 2Glaucoma Unit, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, AustraliaCorrespondence: Alon M Salby Email amicahmd@gmail.comPurpose: This retrospective audit aimed to evaluate the impact of combined iStent® Inject (iSI) and phacoemulsification on medication number in Australians with open-angle glaucoma. Secondary outcomes included intraocular pressure (IOP), best-corrected visual acuity, refraction and visual fields.Patients and Methods: Patients with glaucoma that received combined iSI and phacoemulsification by the same surgeon between 1 February 2016 and 1 February 2018 were audited for postoperative medication number, pressures after 1 day, 1 week, 4 weeks and 6, 12, 18 and 24 months, visual acuity, refraction and visual fields. These parameters were compared to baseline levels and with those from a separate cohort of patients without glaucoma that received standalone phacoemulsification.Results: Forty-one patients (63 eyes) received the combined procedure. Thirty-four patients (59 eyes) received standalone phacoemulsification. Four weeks after receiving combined iSI and phacoemulsification the mean medication number was significantly reduced by 1.3 (p < 0.001) for those on medication at baseline and by 0.5 (p = 0.002) overall. Mean IOP was significantly reduced from baseline after 6 months (– 16%; p = 0.012; n = 35) and 12 months (– 29%; p = 0.004; n = 16). Patients receiving standalone phacoemulsification had short-term reductions in IOP at 4 weeks (– 8%; p < 0.001; n = 57) and 6 months (– 16%; p < 0.001; n = 32). These patients without glaucoma had lower pressures overall compared to those with glaucoma that received the combined procedure (p = 0.019). There were no differences in final visual acuity or refractive outcomes between groups.Conclusion: This audit suggests that iSI and phacoemulsification are at least as effective in controlling IOP as medical therapy. It may have an important role in reducing the medication burden in Australians with cataract and glaucoma. This study is one of the first to confirm refractive stability in concomitant iSI and phacoemulsification.Keywords: glaucoma, iStent Inject, micro-invasive glaucoma surgery, trabecular micro-bypass, phacoemulsification