Comparison of minimally invasive glaucoma surgery with trabecular micro-bypass stent and microhook ab interno trabeculotomy performed in conjunction with cataract surgery

AIM: To evaluate the effectuality and safety of cataract surgery combined with either ab interno trabeculotomy by the microhook(μLOT) or a single i Stent? trabecular bypass implantation(i Stent) in eyes with cataract and mild-tomoderate glaucoma. METHODS: This study enrolled subjects with mild-tomoderate open angle glaucoma with visually significant cataract who used two or more ophthalmic antiglaucoma agents between 60 and 90 y of age. Patients underwent cataract surgery cooperated with either implantation of an i Stent(i Stent-phaco) or excisional goniotomy with the μLOT(μLOT-phaco). Patients underwent μLOT-phaco in the eye with lower the mean deviation, according to the Humphrey field analyzer, while i Stent-phaco was carried out on the other eye. Intraocular pressure(IOP) pre-and post-surgery, alterations in anterior chamber flare(ACF), and corneal endothelial cell density(ECD) were estimated.RESULTS: Twenty subjects were enrolled(mean age: 73.6±7.3 y). The mean medicated preoperative IOP was 16.7 mm Hg in the μLOT and 16.2 mm Hg in the i Stent eyes. The mean final IOP at 12 mo was 13.6 mm Hg in the μLOT eyes and 13.6 mm Hg in the i Stent eyes, representing a 17.8% and 17.2% reduction, respectively. The preoperative ACF in the μLOT eyes was 9.5 pc/ms and it returned to normal in 30 d postoperatively, with a value of 11.4 pc/ms. In the i Stent eyes, ACF was 9.6 pc/ms preoperatively and it returned to normal by 7 d postoperatively(11.2 pc/ms atday 7), demonstrating that postoperative inflammation was less in the i Stent eyes. The corneal ECD in both groups was not significantly decreased.CONCLUSION: In this study, i Stent and μLOT are both effective through 12 mo of follow-up. Safety is more favorable in the i Stent eyes, based on early anterior chamber inflammation.

XEN® Gel Implant for Glaucoma;Prospective Cohort Study in a High-Volume Department

Purpose: To evaluate the 3-year efficiency and safety of XEN® 45 gel stent implantation in a heterogenous group of open angle glaucoma patients. Methods: In this prospective, non-randomized observational study we identified patients who had undergone either stand-alone XEN® implantation (XEN solo) or XEN® implantation in combination with phacoemulsification (XEN combi). All patients who had undergone an implantation during the period 01.04.17-31.10.19 at the Department of Ophthalmology, Drammen Hospital, Norway, were asked to participate. Success was defined as IOP between 5 - 18 mmHg and 20% pressure reduction without medications. Qualified success required the same pressure interval and reduction but allowed medications. The procedure was deemed as failure if pressure requirements were not met, vision was reduced to light perception or worse, or if there was a converion to secondary glaucoma surgery. Results: Out of 115 patients and 133 eyes identified, 87 patients and 99 eyes consented to participate. All patients were Caucasians with a mean age of 73.6 years. The study had a mean (range) follow-up of 38.9 (28 - 54) months. The mean medicated baseline (SD) was reduced from 22.6 (7.9) mmHg on 3.2 (1.1) medications to 14.2 (5.6) mmHg on 1.4 (1.6) medications. Success and qualified success were achieved in 22.2% and 21.2%, respectively. Needling was performed in 34 eyes. Conclusion: XEN® 45 gel stent implantation is a safe procedure, offering a significantly lower IOP and number of medications in a subset of patients with open angle glaucoma.

Trends in operating room-based glaucoma procedures at a single eye center from 2016–2020

AIM:To evaluate trends in glaucoma procedures at the Peking University Eye Center in 2016–2020.METHODS:A retrospective search of all glaucoma procedures performed at our institution were performed.Data were analyzed by calculating the absolute numbers and relative weightage of each procedure per year.RESULTS:The average age of glaucoma patients undergoing surgical procedures was 62.33±17.87y,and 55%were women.From 2016 to 2019,the number of surgical procedures performed in glaucoma patients showed an overall upward trend from 749 to 1460,although it decreased slightly in 2020(n=1393),probably due to the COVID-19 pandemic.The number of trabeculectomies did not change significantly in 2016(n=161)to 2018(n=164)but decreased in 2019(n=139)to 2020(n=121),indicating a reduction in its relative weightage among glaucoma procedures(from 21.50%to 8.69%).The number of glaucoma drainage device implantations and minimally invasive glaucoma surgeries both increased(50and 58 respectively in 2019),except in 2020.The number of transscleral cyclophotocoagulation procedures was relatively stable,increasing until 2017(n=218)and then decreasing.Cataract surgeries with or without glaucoma procedures accounted for a large number of the total surgeries,increasing from 247(32.97%)in 2016 to 967(69.42%),among which cataract extraction combined with goniosynechialysis was the most frequent.CONCLUSION:The overall increase in the number of operating room-based surgical procedures is significant.Trabeculectomy is one of the most commonly performed procedures,despite the relative decline in its weightage.Other procedures,including use of glaucoma drainage devices and mini shunts and minimally invasive glaucoma surgeries,are gaining greater acceptance.Notably,lensrelated surgery plays an important role in glaucoma management.

A narrative review of ocular surface disease considerations in the management of glaucoma

s from those searches were screened for relevance to our review topics.Publications were included if the subjects included glaucoma patients,and if ocular surface outcomes were described.Non-English papers were excluded.Key Content and Findings:Topical glaucoma medications frequently cause adverse effects on the ocular surface,both through direct action of the medications themselves as well as through toxicity from their associated preservatives.Optimization of the ocular surface may improve medication compliance rates.Traditional surgical treatments for glaucoma,such as trabeculectomy,can exacerbate OSD by disrupting the ocular surface but can also reduce the need for chronic medications.Optimization of ocular surface health is imperative in reducing trabeculectomy complication rates,while also potentially reducing the need for trabeculectomy in patients that are able to achieve intraocular pressure control through improved drop tolerability.The introduction of MIGS represents a promising alternative to existing therapies and has been shown to alleviate the overall medication burden.It would be reasonable to assume that decreasing the medication burden could reduce OSD prevalence and severity.However,more research is needed to directly assess the extent of improvement seen after MIGS.Conclusions:A comprehensive understanding of the importance of OSD in medical and surgical management of glaucoma is essential in optimizing patient care and improving outcomes.

Narrative review of goniotomy with the Kahook Dual Blade for the treatment of glaucoma

Glaucoma is a group of eye diseases that seriously threaten human visual health.Increased intraocular pressure is the main clinical manifestation and diagnostic basis of glaucoma and is directly related to increased resistance to aqueous circulation channels.The trabecular meshwork(TM)is a multi-layer spongy tissue that filters aqueous humor.Its structure changes and the filtering capacity decreases,leading to an increase in intraocular pressure.Surgical methods for TM are constantly updated.Compared with traditional glaucoma surgical techniques,such as external trabeculectomy,the development of a new surgical technique-minimally invasive glaucoma surgery(MIGS)-enables the operation to reduce intraocular pressure efficiently while further reducing damage to the eye.MIGS achieves the purpose of surgery mainly by optimizing the TM outflow pathway,uveoscleral outflow pathway,and subconjunctival outflow pathway.A new surgical instrument,the Kahook Dual Blade,appears to optimize the TM outflow pathway in the surgical technique.The Kahook Dual Blade is a new type of angle incision instrument.Because of its unique double-edged design,in the process of goniotomy,it can effectively reduce the damage to the anterior chamber angle structure and accurately remove the appropriate amount of TM so that the aqueous humor can flow out smoothly.Kahook Dual Blade goniotomy has the advantages of avoiding complications and foreign body sensation caused by intraocular implants.The operation time is relatively short,the surgical technique is easy to master,and the TM resection scope can be determined based on the patient’s condition.It can be used to treat some clinically meaningful glaucoma.This article is organized as follows.We present the following article following the Narrative Review reporting checklist.

One-year outcomes and predictable factors for microhook ab interno trabeculotomy

AIM: To investigate the one-year outcomes and factors that influence the results of microhook ab interno trabeculotomy(μLOT). METHODS: The medical records of consecutive patients with open angle glaucoma who underwent μLOT(including combination of μLOT and cataract surgery) between Februar y 2018 and July 2019 were retrospectively reviewed. Surgical success was defined as the following: an intraocular pressure(IOP)≤21 mm Hg or IOP≤preoperative IOP with a reduced number of glaucoma eye drops, without additional glaucoma surgery, and assessed using KaplanMeier survival analysis. A multivariate Cox proportionalhazards regression model was used to investigate the factors associated with surgical failure.RESULTS: The 59 eyes of 59 patients comprising 28 eyes with primary open angle glaucoma(POAG) and 31 with secondary open angle glaucoma(SOAG) were included. The mean IOP and number of glaucoma eye drops significantly decreased from 25.3±7.2 mm Hg and 3.9±1.1, preoperatively to 16.1±4.4 mm Hg(P<0.01) and 2.1±1.8(P<0.01),respectively, 12 mo postoperatively, with a cumulative success rate of 63.1%. The one-year success rate was significantly higher in POAG eyes than in SOAG eyes(80.0% vs 48.0%;P=0.011, log-rank test). Multivariate analyses revealed SOAG [P=0.017, adjusted hazard ratio(a HR): 3.468, 95%CI: 1.246-9.654] and the postoperative IOP spike(IOP>25 mm Hg within 2 wk post-surgery;P<0.001, a HR: 5.382, 95%CI:2.113-13.707) as independent factors associated with surgical failure.CONCLUSION: The μLOT is a good treatment option for POAG eyes. However, the postoperative course should be carefully followed in cases with postoperative IOP spike.

Hydrus microstent implantation for surgical management of glaucoma: a review of design, efficacy and safety

With the advent of microinvasive glaucoma surgery(MIGS),the spectrum of modalities available to manage patients with this chronic and heterogeneous condition has broadened.Despite its novelty however,there has been a rapid evolution in the development of a multitude of devices,each targeting a structure along the aqueous drainage pathway.A growing body of evidence has demonstrated IOP and medication burden reduction,and a more favorable safety profile with MIGS procedures in contrast to traditional incisional surgeries.Among the array of MIGS,the Hydrus®Microstent(Ivantis,Inc.,Irvine,CA)is a recent FDA approved device,designed to bypass the trabecular meshwork and provide a scaffold for Schlemm’s canal.The objective of this article is to review the Hydrus from conception to clinical use,and present data on its efficacy and safety to date.The available literature has shown promise,however inherent to all novel devices,only longterm monitoring will ensure sustained IOP control and an acceptable safety profile.Surgical advancements in glaucoma have revolutionized the field,and continued research and development will establish these approaches in clinical treatment algorithms.

Safety and efficacy outcomes of the Xen45 Gel Stent use for refractory glaucoma:a surgery series from surgeon trainees at a tertiary teaching hospital

Background:To study the effect of an ab interno gelatin stent(XEN45 Gel Stent,Allergan Inc.,Irvine,California,USA)on intraocular pressure(IOP)as placed by glaucoma fellowship trainees in eyes with refractory glaucoma.Methods:A prospective noncomparative study at a tertiary training center on 28 unique eyes undergoing ab interno gelatin stent implantation by glaucoma fellowship trainees.Data was collected at baseline and postoperatively at day 1,week 1,and months 1,3,5,and 12.Primary outcome was mean IOP change.Secondary outcomes included change in number of glaucoma medication classes and visual acuity.Safety outcomes included needling rates.Surgical success was defined by achieving≥20%reduction in IOP with the same or fewer classes of antiglaucoma medications from baseline without the need for secondary surgical intervention and/or stent removal.Results:At baseline,28.6%(8/28)of the subjects had prior failed incisional glaucoma surgery in a study population that was 54%African-American,with 78%with severe glaucoma(average mean deviation of−14.58 dB).Thirteen subjects terminated their clinic visits before their 12-month postoperative visit,leaving 15 subjects for end point analysis.Average IOP went from 21.6 mmHg(range 12.0–31.0,SD 6.6)at baseline to 12.5 mmHg(range 7.0–19.0,SD 3.6),a 42.1%reduction(p<0.007).All subjects decreased the number of medication classes they were taking with an average reduction of 3.8(range 2–5,SD 0.9)to 1.3(range 0–3,SD 1.0)classes,or a 65.8%decrease(p<0.006).Crude surgical success was 80.0%for the 15 subjects that followed up at 12 months.The Kaplan-Meier cumulative probability of success for all 28 subjects at 12 months was 70.4%(95%CI:44.7–85.8%).Regardless of the length of follow-up,21.4%(6/28)met failure criteria:3 subjects failed because they required secondary surgical intervention,and the other 3 did not have adequate IOP reduction.Initial bleb needling rate was 28.6%(8/28)and repeat was 17.9%(5/28).Conclusions:Compared to the reported literature with experienced ocular surgeons,ab interno gel stent placements by glaucoma fellowship trainees have similar mean IOP,topical medication reduction,surgical success,and needling rates at 12-month follow-up.

iStent inject trabecular microbypass stent implantation with cataract extraction in open-angle glaucoma:early clinical experience

Background:Retrospective,consecutive case series to evaluate the implantation of two second-generation trabecular microbypass stents in combination with cataract surgery in a real-world,clinical setting.Methods:The series included 56 eyes implanted with the iStent inject device with phacoemulsification.The series consisted of eyes with primary open-angle glaucoma(n=52)and pseudoexfoliative glaucoma(n=4).Primary outcome measures included intraocular pressure(IOP)and number of glaucoma medications.Safety outcomes included the need for secondary surgical intervention and the incidence of IOP spikes≥10 mmHg and≥15 mmHg.Results:IOP was reduced by 21%to 14.7±2.9 mmHg(p<0.01)at 6 months postoperative from 18.7±5.8 mmHg at baseline.Preoperatively,the mean number of glaucoma medications was 1.5±0.9 and reduced by 39%to 0.9±1.2(p<0.01)at 6 months.At 6 months,68%of eyes had an IOP≤15 mmHg,increased from 30%at baseline.55%of eyes were medication-free at 6 months,up from 18%at baseline.There were no severe postoperative complications.No eyes underwent an additional glaucoma procedure.Conclusions:Implantation of the iStent inject device with concomitant cataract surgery effectively provides a sustained reduction in IOP with a markedly improved medication burden out to 6 months postoperative.The safety profile is excellent.

Long‑term outcomes of two first‑generation trabecular micro‑bypass stents(iStent)with phacoemulsification in primary open‑angle glaucoma:eight‑year results

Background:The short-and medium-term outcomes of iStent have been extensively studied;however,only few studies have investigated its long-term outcomes.Here,we assessed the long-term efficacy and safety of two iStents with concomitant cataract surgery in glaucomatous eyes while also evaluating measures of disease stability using visual field and optical coherence tomography(OCT)of the optic nerve and the macula throughout 8 years of follow-up.Methods:This longitudinal,single-center consecutive case series included glaucomatous eyes that underwent implantation of two first-generation trabecular micro-bypass stents(iStent)with concomitant cataract surgery.Eight-year efficacy outcomes included mean intraocular pressure(IOP)and medications,as well as surgical success.Eight-year safety outcomes included best-corrected visual acuity(BCVA),visual field mean deviation(VF-MD),cup-todisc ratio(CDR),retinal nerve fiber layer(RNFL)thickness,ganglion cell-inner plexiform layer(GC-IPL)thickness,and adverse events.Results:A total of 62 eyes with primary open-angle glaucoma(POAG)were included.At 8 years postoperative,IOP reduced by 26%from 19.2±3.9 mmHg preoperatively to 14.2±2.4 mmHg(P<0.001),91.1%of eyes achieved IOP≤18 mmHg(vs.51.6%preoperatively),69.6%of eyes achieved IOP≤15 mmHg(vs.14.5%preoperatively),and 25%of eyes achieved IOP≤12 mmHg(vs.1.6%preoperatively).Medication use decreased by 17.9%from 2.8±1.1 preoperatively to 2.3±1.2(P=0.018).Surgical success was 90%,as six eyes underwent subsequent glaucoma surgeries.Safety measures of BCVA,CDR,RNFL thickness and GC-IPL thickness remained stable through 8 years postoperative.VF-MD remained stable until postoperative year 5 and subsequently progressed according to the natural history of glaucomatous disease.Conclusions:Implantation of two iStents with concomitant cataract surgery is an effective and safe treatment option for surgery-naïve POAG eyes,evidenced by significant IOP and medication reductions,reasonable surgical success,and favorable safety outcomes,throughout the 8-year follow-up.Our data additionally supports the efficacy of this combined procedure in stabilizing or slowing disease progression.

Long-term outcomes of two first-generation trabecular micro-bypass stents (iStent) with phacoemulsification in primary open-angle glaucoma: eight-year results

Background:The short-and medium-term outcomes of iStent have been extensively studied;however,only few studies have investigated its long-term outcomes.Here,we assessed the long-term efficacy and safety of two iStents with concomitant cataract surgery in glaucomatous eyes while also evaluating measures of disease stability using vis-ual field and optical coherence tomography(OCT)of the optic nerve and the macula throughout eight years of follow-up.Methods:This longitudinal,single-center consecutive case series included glaucomatous eyes that underwent implantation of two first-generation trabecular micro-bypass stents(iStent)with concomitant cataract surgery.Eight-year efficacy outcomes included mean intraocular pressure(IOP)and medications,as well as surgical success.Eight-year safety outcomes included best-corrected visual acuity(BCVA),visual field mean deviation(VF-MD),cup-to-disc ratio(CDR),retinal nerve fiber layer(RNFL)thickness,ganglion cell-inner plexiform layer(GC-IPL)thickness,and adverse events.Results:A total of 62 eyes with primary open-angle glaucoma(POAG)were included.At eight years postoperative,IOP reduced by 26%from 19.2±3.9 mmHg preoperatively to 14.2±2.4 mmHg(P<0.001),91.1%of eyes achieved IOP≤18 mmHg(vs.51.6%preoperatively),69.6%of eyes achieved IOP≤15 mmHg(vs.14.5%preoperatively),and 25%of eyes achieved 1OP≤12 mmHg(vs.1.6%preoperatively).Medication use decreased by 17.9%from 2.8±1.1 preoperatively to 2.3±1.2(P=0.018).Surgical success rate was 90%,as six eyes underwent subsequent glaucoma surgeries.Safety measures of BCVA,CDR,RNFL thickness and GC-IPL thickness remained stable through eight years postoperative.VF-MD remained stable until postoperative year five and subsequently progressed according to the natural history of glaucomatous disease.Conclusions:Implantation of two iStents with concomitant cataract surgery is an effective and safe treatment option for surgery-naive POAG eyes,evidenced by significant IOP and medication reductions,reasonable surgical suc-cess,and favorable safety outcomes,throughout the eight-year follow-up.Our data additionally support the efficacy of this combined procedure in stabilizing or slowing disease progression.

iStent inject trabecular microbypass stent implantation with cataract extraction in open-angle glaucoma:early clinical experience

Background:Retrospective,consecutive case series to evaluate the implantation of two sec on d-generation trabecular microbypass stents in combination with cataract surgery in a real-world,clinical setting.Methods:The series in eluded 56 eyes implanted with the iSte nt inject device with phacoemulsification.The series consisted of eyes with primary open-angle glaucoma(n=52)and pseudoexfoliative glaucoma(n=4).Primary outcome measures included intraocular pressure(IOP)and number of glaucoma medications.Safety outcomes included the need for secondary surgical intervention and the incidence of IOP spikes>10 mmHg and>15 mmHg.Results:IOP was reduced by 21%to 14.7±2.9 mmHg(P<0.01)at 6 months postoperative from 18.7±5.8 mmHg at baseline.Preoperatively,the mean number of glaucoma medications was 1.5±0.9 and reduced by 39% to 0.9±1.2(P<0.01)at 6 months.At 6 months,68%of eyes had an IOP<15 mmHg,increased from 30%at baseline.55%of eyes were medicati on-free at 6 months,up from 18%at baseline.There were no severe postoperative complications.No eyes underwent an additional glaucoma procedure.Conclusions:Implantation of the iStent inject device with concomitant cataract surgery effectively provides a sustained reduction in IOP with a markedly improved medication burden out to 6 months postoperative.The safety profile is excellent.

Development and material characteristics of glaucoma surgical implants

Background:Glaucoma is the leading cause of irreversible blindness worldwide.The reduction of intraocular pressure has proved to be the only factor which can be modified in the treatment,and surgical management is one of the important methods for the treatment of glaucoma patients.Main text:In order to increase aqueous humor outflow and further reduce intraocular pressure,various drainage implants have been designed and applied in clinical practice.From initial Molteno,Baerveldt and Ahmed glaucoma implants to the Ahmed ClearPath device,Paul glaucoma implant,EX-PRESS and the eyeWatch implant,to iStent,Hydrus,XEN,PreserFlo,Cypass,SOLX Gold Shunt,etc.,glaucoma surgical implants are currently undergoing a massive transformation on their structures and performances.Multitudinous materials have been used to produce these implants,from original silicone and porous polyethylene,to gelatin,stainless steel,SIBS,titanium,nitinol and even 24-carat gold.Moreover,the material geometry,size,rigidity,biocompatibility and mechanism(valved versus nonvalved)among these implants are markedly different.In this review,we discussed the development and material characteristics of both conventional glaucoma drainage devices and more recent implants,such as the eyeWatch and the new minimally invasive glaucoma surgery(MIGS)devices.Conclusions:Although different in design and materials,these delicate glaucoma surgical implants have widely expanded the glaucoma surgical methods,and improved the success rate and safety of glaucoma surgery significantly.However,all of these glaucoma surgical implants have various limitations and should be used for different glaucoma patients at different conditions.

Assessing XEN microstent’s one-year efficacy:independent of site variability

AIM:To evaluate the short-term efficacy of XEN45 Gel Stent(XEN)implantation for primary open angle glaucoma(POAG)and pseudoexfoliation(PEX)glaucoma across two university eye clinics,aiming to assess the impact of varying center-specific protocols during the first postoperative year.METHODS:We retrospectively examined 282 patients(183 in center 1,99 in center 2),who underwent XEN microstent implantation for uncontrolled POAG or PEX glaucoma.Parameters including intraocular pressure(IOP),IOP-lowering medication count,best corrected visual acuity(BCVA),and postoperative complications were evaluated over 12mo.RESULTS:Post-implantation,center 1 reported a mean IOP reduction from 25.3±7.4 to 14.1±4.7 mm Hg(P<0.01)and a decrease in IOP-lowering medications from 3.2±1.2 to 1.0±1.3(P<0.01).Center 2 observed a similar reduction from 24.4±6.5 to 15.1±5.5 mm Hg(P<0.01)and medication decrease from 3.0±1.1 to 1.2±1.0(P<0.01).BCVA remained stable in both cohorts.The most common complications were hypotony(center 1:32;center 2:20)and choroidal detachment(center 1:22,center 2:15),with nearly identical needling rates(40% in center 1,41% in center 2).CONCLUSION:XEN implantation yields consistent reductions in IOP and medication use across different centers using comparable surgical and postoperative treatment regime.These findings underscore XEN’s shortterm effectiveness and suggest standardizable outcomes regardless of exact surgical procedure or treatment differences.

Prospective 12‑month outcomes of combined iStent inject implantation and phacoemulsification in Asian eyes with normal tension glaucoma

Background:Glaucoma is the leading cause of irreversible blindness.Normal tension glaucoma(NTG)is a subset of open-angle glaucoma,demonstrating glaucomatous optic nerve damage in the absence of raised intraocular pressure(IOP).NTG is more prevalent in Asian populations.While generally slow-progressing,NTG may be associated with significant central visual field loss.In recent years,minimally invasive glaucoma surgery has been added to the armamentarium of glaucoma surgery.This prospective study aims to evaluate 12-month surgical outcomes of combined iStent inject(Glaukos Corporation,Laguna Hills,CA)implantation and phacoemulsification in Asian eyes with NTG.Methods:This is a prospective,single-centre case series of 30 eyes followed up until 12 months after surgery.Outcome measures included IOP,number of glaucoma medications,best-corrected visual acuity(BCVA)and intra and postoperative complications.Results:Mean age of subjects was 73.1±6.3 years.Majority were ethnic Chinese(n=27,90%).Baseline medicated mean IOP was 13.8±2.4 mmHg and mean number of glaucoma medications was 1.3±0.7.Mean Humphrey visual field mean deviation was−13.7±7.6.The mean IOP reduction at all timepoints from postoperative month(POM)3 onwards was statistically significant(all P<0.05),with mean reduction of 1.2 mmHg(95%CI:0.1–2.2,P=0.037)by POM12.There was statistically significant reduction in mean number of medications from postoperative day(POD)1 onwards(all P<0.05),with mean decrease of 1.0 medication(95%CI:0.9–1.1,P<0.001)by POM12.By POM12,25(83.3%)eyes were medication-free.Three(10%)eyes had stent occlusion by iris requiring laser iridoplasty.One eye had gross hyphema which resolved on conservative management before POM1.Mean BCVA improved from the baseline 0.3±0.3 logMAR to 0.1±0.1 logMAR postoperatively(P<0.001).There were no major adverse or sight-threatening events.No eyes required further glaucoma surgery during the 12-month follow-up period.Conclusion:Asian eyes with NTG which underwent combined iStent inject implantation and phacoemulsification demonstrated a significant and sustained reduction in IOP and glaucoma medications,up to 12 months postoperatively.