Refractive Outcomes After Trabecular Micro-Bypass Stents (iStent Inject) with Cataract Extraction in Open-Angle Glaucoma

Alexandros S Ioannidis, 1, 2 Marc Töteberg-Harms, 3 Timothy Hamann, 3 Christopher Hodge 1, 4, 5 1Vision Eye Institute Blackburn South, Melbourne, VIC, Australia; 2Royal Melbourne Hospital, Melbourne, VIC, Australia; 3Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland; 4Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; 5Graduate School of Health, University of Technology Sydney, Sydney, NSW, AustraliaCorrespondence: Alexandros S IoannidisVision Eye Institute Blackburn South, 156 Canterbury Road, Blackburn South, VIC 3130, AustraliaTel +61 3 9877 6288Fax +61 3 9894 2691Email alexioannidis.ai@gmail.comPurpose: Simultaneous cataract and glaucoma surgery has traditionally been challenging for the anterior segment surgeon. The introduction of minimally invasive glaucoma surgery (MIGS) in conjunction with cataract surgery appears safe and effective in lowering intraocular pressure. Although a significant visual impact leading from the combined procedure is unexpected, we aim to describe the refractive outcomes in a cohort of patients undergoing simultaneous cataract removal and iStent inject and discuss the potential implications of combined surgery in patients with co-existent glaucoma.Patients and Methods: This is a retrospective consecutive case series inclusive of patients undergoing combined femtosecond laser-assisted cataract surgery and the insertion of two trabecular micro-bypass stents (iStent inject). Visual acuity, refraction and astigmatic vector analysis were collated and analysed from the preoperative and 4 weeks postoperative visits.Results: One hundred and six eyes of 89 patients from 2 surgeons were included in the original cohort. The mean absolute difference from target refraction was 0.36 ± 0.25D. 73.9% of eyes were within ± 0.5D of the refractive target and 98.9% of eyes were within ± 1.00D. 73.8% of eyes had 0.5D or less residual refractive astigmatism following the procedure.Conclusion: We present a novel cohort of glaucoma patients undergoing combined trabecular micro-bypass stents (iStent inject) and cataract surgery achieving excellent refractive outcomes. The results of this study indicate that this second-generation device is refractively neutral.Keywords: glaucoma, cataract surgery, trabecular micro-bypass stents, astigmatism, intraocular lenses