Intraoperative iStent versus postoperative selective laser trabeculoplasty in early glaucoma patients undergoing cataract surgery: A retrospective comparative study

Purpose. - To compare the efficacy and safety of iStent inject (R) versus 360 degrees selective laser trabeculoplasty (SLT) in patients with early glaucoma undergoing cataract surgery. Methods. - A retrospective non -randomized study was conducted in 73 eyes divided into two groups: cataract surgery + intraoperative iStent (n = 40) versus cataract surgery + postoperative SLT at one month (n = 33). The primary endpoint was intraocular pressure (IOP) lowering >= 20% between baseline and 6 months postoperatively. The secondary endpoints were IOP lowering at 1, 6 and 12 months, and the mean number of IOP-lowering medications at 6 and 12 months. Results. - The mean baseline IOP was 19.1 mmHg with no significant difference between groups. The mean baseline number of IOP-lowering medications was higher in the iStent group (n = 1.95) compared to the SLT group (n = 1.53; P = 0.04). At 6 months, 18 (60%) patients in the SLT group and 20 (51%) patients in the iStent group achieved IOP lowering >= 20% with no significant difference between groups (P = 0.431). At 6 months, no difference in the mean number of IOPlowering medications was found between groups (-0.92 and -0.89 in the iStent and SLT groups, respectively). Similar results were found at 12 months. Conclusion. - These results suggest similar safety and efficacy of intraoperative iStent and postoperative 360 degrees SLT in lowering IOP and reducing glaucoma eye drops in early glaucoma patients undergoing cataract surgery. Treatment choice should be based on the ophthalmologist's experience and on the cost -benefit ratio. (c) 2023 Elsevier Masson SAS. All rights reserved.