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Outcomes of phacoemulsification combined with two iStent inject trabecular microbypass stents with or without endocyclophotocoagulation
  1. Anca Delia Pantalon1,2,
  2. Andre Diogo De Oliveira Barata1,3,
  3. Minas Georgopoulos1,4,
  4. Gokulan Ratnarajan1
  1. 1 Eye Unit and Eye Bank, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
  2. 2 Ophthalmology, “St. Spiridon” University Hospital, Iasi, Romania
  3. 3 Ophthalmology, Santa Maria Central Hospital, Lisbon, Portugal
  4. 4 Ophthalmology, East Surrey Hospital, Redhill, UK
  1. Correspondence to Dr Gokulan Ratnarajan, Eye Unit and Eye Bank, Queen Victoria Hospital NHS Foundation Trust, East Grinstead RH19 3DZ, UK; g.ratnarajan{at}


Aim Comparing outcomes after combined phacoemulsification, two iStents insertion and endocyclophotocoagulation (ECP) versus phacoemulsification-iStents alone.

Methods This is a longitudinal retrospective 12 months study in eyes with ocular hypertension or early-to-moderate open angle glaucoma. Level of disease, intraocular pressure (IOP) and tolerance of glaucoma medication were considered before planning surgery. Best-corrected visual acuity (BCVA-logMAR), IOP (mm Hg), number of medications were assessed at baseline, week 1, week 5, month 3, 6, 12 postop. Main outcome: percentage (%) in IOP reduction at 12 months vs medicated baseline. Secondary outcomes: absolute values of IOP/medication reduction, BCVA and postop complications.

Results The ICE2 (two iStents-cataract extraction-ECP) group included 63 eyes and Phaco-iStent group included 46 eyes. Baseline IOP was higher in the ICE2 than phaco-iStent group (19.97±4.31 mm Hg vs 17.63±3.86 mm Hg, p=0.004) and mean deviation was lower (−7.20±2.58 dB vs −4.94±4.51 dB, p=0.037). Number of medications were comparable at baseline: 2.22±1.06 (ICE2) vs 2.07±1.02 (phaco-iStent), p=0.442. At month 12 postop, IOP in the ICE2 group decreased 35% from baseline vs 21% in the phaco-iStent group (p=0.03); absolute IOP reduction was significantly lower than baseline in each group (p<0.001), yet final IOP was lower in the ICE2 group than phaco-iStent group (13.05±2.18 mm Hg vs 14.09±1.86 mm Hg, p=0.01). Similar results were found for glaucoma medication (1.24±1.05 in ICE2 group vs 1.39±1.03 in phaco-iStent group, p=0.01). Final BCVA was 0.11±0.18 (phaco-iStent group) vs 0.08±0.08 (ICE2 group), p=0.309. Safety outcomes were comparable between groups.

Conclusion ICE2 procedure offers better results in IOP/medication reduction at 12 months than phacoemulsification-iStents alone.

  • glaucoma
  • aqueous humour
  • treatment surgery
  • angle

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  • Contributors ADP, ADDOB, MG and GR contributed to the design of the study, data collection, analysis and interpretation. ADP and GR drafted the manuscript and ADP, ADDOB, MG and GR critically revised it. All authors approved the final version published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests GR is a consultant for Glaukos Inc.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. All data relevant to this study are included in the article or uploaded as supplementary information. Databases containing the deidentified participant data and clinical parameters are available on request from the corresponding author. Reuse is prohibited under all circumstances.