COMMENTARY

Two-Stent Implantation for IOP Reduction in Primary Open-Angle Glaucoma

Shuchi B. Patel, MD

Disclosures

February 17, 2017

Newly Diagnosed Primary Open-Angle Glaucoma Randomized to 2 Trabecular Bypass Stents or Prostaglandin: Outcomes Through 36 Months

Vold SD, Voskanyan L, Tetz M, et al
Ophthalmol Ther. 2016;5:161-172

Study Summary

This was a prospective unmasked randomized trial comparing the efficacy of two trabecular bypass stents with topical prostaglandin therapy in patients with newly diagnosed primary open-angle glaucoma (POAG).

All patients were phakic and naive to any previous therapeutic or surgical intervention, and had pretreatment intraocular pressures (IOPs) of ≥ 21 mm Hg and ≤ 40 mm Hg. Of the 101 randomized participants, 100 were followed for a minimum of 24 months and 73 were followed for 36 months. Outcomes measured included IOP, the need for additional medication, complications, and safety of the intervention.

Fifty-four participants underwent two-stent surgery and 47 received topical travoprost. Mean pretreatment IOP was statistically similar at around 25 mm Hg in both groups.

At 3 years after treatment, including eyes that needed further treatment, IOP was 14.6 mm Hg in the stent eyes and 15.3 in the travoprost eyes.

More patients in the travoprost group required additional medication, with 11 eyes needing a second medication in that group, compared with six eyes needing medication in the stent group. Criteria for adding medication was IOP ≥ 21 mm Hg or optic nerve head and visual field findings indicating progression of glaucoma.

In the subset of eyes that did not require additional medical therapy, mean IOP was 14.5 mm Hg in the stent group and 15.7 mm Hg in the travoprost group. Of the stent eyes, 91% had an IOP of ≤ 18 mm Hg without additional therapy at 3 years, whereas 79% of the travoprost eyes had similar success.

The two operative complications were a hyphema, which resolved by the first postoperative day, and a small iridodialysis with no visual consequence.

Safety was similar in both groups, with similar rates of cataract progression and neither group having vision-threatening side effects.

Therefore, implantation of two stents as first-line treatment for newly diagnosed POAG may be a viable option, with outcomes comparable to those with prostaglandin therapy.

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