Ab interno canaloplasty combined with trabecular bypass stenting in eyes with primary open-angle glaucoma

PURPOSE: Evaluate outcomes of trabecular meshwork (TM) bypass (iStent(®) GTS100) with cataract extraction (CE) and TM-bypass + ab interno canaloplasty (CP) (VISCO360(®)) with CE in patients with primary open-angle glaucoma (POAG). SETTING: Private surgical center for a comprehensive ophthalmology practice DESIGN: Retrospective analysis of 186 eyes from 130 consecutive patients with 6 months follow-up. METHODS: Eligible eyes had POAG, indicated for CE, and had received CE + TM-bypass or CE + TM-bypass + CP. Exclusions: glaucomas not POAG, SLT within 6 months, or previous ALT. IOP, visual acuity, and medication use assessed at baseline, months 1, 3, and 6. Endpoints were mean reduction in IOP from baseline at 6 months, proportion with IOP reduction at 6 months of ≥20% and IOP <18 mmHg on same or fewer medications, mean medication reduction, and proportion medication independent. RESULTS: Eighty-six eyes comprised the CE + TM-bypass + CP group; 100 eyes in the CE + TM-bypass group. At 6 months: mean IOP reduction was 2.9±3.6 mmHg for CE + TM-bypass + CP and 1.7±3.1 mmHg for CE + TM-bypass group (P<0.05); the proportion with IOP reduction of ≥20% and an IOP <18 mmHg on the same or fewer medications was 46% for CE + TM-bypass + CP and 35% for CE + TM-bypass; for both CE + TM-bypass + CP and CE + TM-bypass, mean number of medications was decreased (0.9 and 0.7, P<0.0001) with 56% and 48% off all medication. The most common AE were inflammation (6%) for CE + TM-bypass + CP group and VA loss (8%) for CE + TM-bypass. CONCLUSION: At six months, a greater proportion of CE + TM-bypass + CP patients achieved IOP reduction of ≥20% and an IOP <18 mmHg on the same or fewer medications than for TM-bypass + CE.