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Editors Selection IGR 14-2

Surgical Treatment: Trabecular micro-bypass stent

Comment by Kuldev Singh on:

27678 Randomized evaluation of the trabecular micro-bypass stent with phacoemulsification in patients with glaucoma and cataract, Samuelson TW; Katz LJ; Wells JM et al., Ophthalmology, 2011; 118: 459-467

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The paper by Samuelson et al. (421) is a prospective randomized clinical trial assessing the safety and efficacy of a trabecular micro-bypass stent in conjunction with cataract surgery versus cataract surgery alone. A substantial proportion of patients undergoing cataract surgery are under treatment for glaucoma, and cataract surgery alone is known to reduce IOP postoperatively, on average, in such patients. The extent of IOP lowering with cataract surgery alone, however, is unpredictable and there is an increasing interest in combining cataract removal with an IOP lowering surgical procedure other than trabeculectomy in an effort to reduce the morbidity of glaucomatous disease and the burden of future glaucoma therapy in many such patients. Combined cataract surgery and trabeculectomy remains a reasonable option in high risk glaucoma patients with coexistent cataract, particularly in circumstances when IOP is not adequately controlled preoperatively. The trabecular micro-bypass stent was found to be reasonably safe over the one year postoperative period and resulted in a reduction in the proportion of patients requiring postoperative IOP lowering medications to reach an IOP less than or equal to 21 mmHg relative to cataract surgery alone. It will be interesting to follow the long-term IOP-lowering potential of this device as well as how it compares with regard to safety and efficacy relative to other novel glaucoma surgical approaches that are being combined with cataract surgery.

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