Abstract
Background:Glaucoma is the leading cause of irreversible blindness.Normal tension glaucoma(NTG)is a subset of open-angle glaucoma,demonstrating glaucomatous optic nerve damage in the absence of raised intraocular pres-sure(IOP).NTG is more prevalent in Asian populations.While generally slow-progressing,NTG may be associated with significant central visual field loss.In recent years,minimally invasive glaucoma surgery has been added to the arma-mentarium of glaucoma surgery.This prospective study aims to evaluate 12-month surgical outcomes of combined iStent inject(Glaukos Corporation,Laguna Hills,CA)implantation and phacoemulsification in Asian eyes with NTG.Methods:This is a prospective,single-center case series of 30 eyes followed up until 12 months after surgery.Out-come measures included IOP,number of glaucoma medications,best-corrected visual acuity(BCVA)and intra-and postoperative complications.Results:Mean age of subjects was 73.1±6.3 years.Majority were ethnic Chinese(n=27,90％).Baseline medicated mean IOP was 13.8±2.4 mmHg and mean number of glaucoma medications was 1.3±0.7.Mean Humphrey visual field mean deviation was-13.7±7.6 dB.The mean IOP reduction at all timepoints from postoperative month(POM)3 onwards was statistically significant(all P＜0.05),with mean reduction of 1.2 mmHg(95％CI:0.1-2.2,P=0.037)by POM12.There was statistically significant reduction in mean number of medications from postoperative day(POD)1 onwards(all P＜0.05),with mean decrease of 1.0 medication(95％CI:0.9-1.1,P＜0.001)by POM12.By POM12,25(83.3％)eyes were medication-free.Three(10％)eyes had stent occlusion by iris requiring laser iridoplasty.One eye had gross hyphema which resolved on conservative management before POM1.Mean BCVA improved from the baseline 0.3±0.3 logMAR to 0.1±0.1 logMAR postoperatively(P＜0.001).There were no major adverse or sight-threat-ening events.No eyes required further glaucoma surgery during the 12-month follow-up period.Conclusion:Asian eyes with NTG which underwent combined iStent inject implantation and phacoemulsifica-tion demonstrated a significant and sustained reduction in IOP and glaucoma medications,up to 12 months postoperatively.
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