Combined phacoemulsification with gelatin stent vs SIBS microshunt

Theme: Glaucoma
What: Glaucoma
Part of: Glaucoma II: Surgery / Glaucome II: Chirurgical
When: 5/31/2024, 02:00 PM - 03:30 PM
Where: Room | Salle 801

Abstract

Purpose: Compare the effectiveness and safety of combined phacoemulsification with gelatin stent or SIBS microshunt.

Study design: Single-center, retrospective, interventional cohort study

Methods: Consecutive patients who had phacoemulsification with 45µm gelatin stent (phaco-gel, n=132) or phacoemulsification with SIBS microshunt (phaco-SIBS, n=72) implantation between Jul 2015 and Dec 2018 were included. Eyes with previous subconjunctival filtration surgery were excluded. Primary outcome was the hazard ratio of treatment failure, defined as any revisions, reoperations, no light perception, or consecutive visits with IOP > 17mmHg, IOP <6 mmHg and >2 lines of vision lost, or less than 20% reduction from baseline IOP after 3 months. “Complete” success required no medications while “qualified” success did not. Secondary outcomes included using 14 and 21 mmHg thresholds, risk factors, IOP and # classes at month 12, interventions, complications, and reoperations.

Results: At baseline, the phaco-gel eyes had a significantly (p<0.05) lower median IOP (20.0 vs 22.0 mmHg), and median #classes (3.0 vs 4.0). Phaco-gel had a significant (p<0.05) association with increased failure compared to phaco-SIBS at all thresholds for both complete and qualified success. Using a threshold of 17mmHg, crude HR of complete failure (95% CI) for phaco-gel was 2.29 (1.55-3.39); and 12-month complete success was 71.6% in phaco-SIBS and 42.1% in phaco-gel. At month 12, there were no significant differences in median IOP but there was a significant difference in #classes. Median IOP (IQR) was 14.0 (11.0, 18.5) in phaco-SIBS and 14.0 (12.0, 16.8) in phaco-gel (p>0.05); and median #classes were 0 (0, 0) in phaco-SIBS and 0 (0, 2) in phaco-gel (p<0.05). In phaco-SIBS, 31.9% underwent needling compared to 33.3% in phaco-gel (OR 1.1, 95%CI 0.6-2.0); 9.7% were revised compared to 6.1% (OR 1.7, 95%CI 0.6-5.0); and 1.4% had a reoperation compared to 6.8% (OR 0.2, 95%CI 0.0-1.2). The phaco-SIBS group had significantly (p<0.05) higher rates of choroidals (15.3% vs 0.8%), leak/dehiscence (6.9% vs 0.8%), and macular edema (5.6% vs 0%).

Conclusion: Phaco-gel was associated with higher rates of failure than phaco-SIBS, but phaco-SIBS was associated with higher rates of complications. Risk for failure and complications are both key considerations when choosing a surgery for patients needing combined cataract and glaucoma surgery.

Presenter(s)

Presenting Author: Richard Zhang

Additional Author(s):

Matthew Schlenker, Prism Eye Institute

Ike Ahmed, Prism Eye Institute

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