Trabecular micro-bypass stent implantation with cataract extraction in pigmentary glaucoma

Importance Use of the trabecular micro-bypass stent with cataract surgery is well established to be safe and effective in primary open-angle glaucoma. This is the first study to exclusively evaluate use of the device in pigmentary glaucoma. Background This study aimed to investigate the safety and efficacy of a trabecular micro-bypass stent in combination with cataract surgery in pigmentary glaucoma. Design Retrospective, consecutive case series. Participants Twenty-four eyes of 12 patients with pigmentary glaucoma implanted with one trabecular micro-bypass stent with concomitant cataract surgery. Methods Baseline data was collected and compared to the following postoperative time points: 1 day, 1 week, 1 month out to 36 months (M36) after the procedure. Main Outcome Measures These included intraocular pressure (IOP), number of glaucoma medications and need for additional surgery. Results At M36 there was a 25% reduction in IOP to 14.68 +/- 3.0 (P < .01) from 19.50 +/- 6.7 mmHg at baseline. The mean number of glaucoma medications was 0.75 +/- 1.0 prior to the surgery and 0.59 +/- 0.6 (P > .05) at 36 M. At the 36 M time-point, 95% of eyes had IOP <= 18 mmHg and 68% of eyes were <= 15 mmHg. No eyes underwent a secondary glaucoma procedure. Conclusions and Relevance The insertion of a single trabecular micro-bypass stent in combination with cataract surgery effectively provides a sustained reduction in IOP up to 3 years after surgery in patients with pigmentary glaucoma. The safety profile is favourable with low rate of IOP spikes and no patients requiring additional surgery.