A non-randomised, comparative case series of combined phacoemulsification with iStent inject W and OMNI surgical system
Abstract
Purpose: To compare efficacy and safety outcomes of phacoemulsification combined with either iStent inject W or OMNI surgical system with different degrees of gonioscopy-assisted transluminal trabeculotomy (GATT) in glaucoma patients.
Design: Single-centre, retrospective, non-randomised comparative cohort study. Subjects: Consecutive cases that underwent phacoemulsification combined with either iStent inject W or OMNI surgical system with at least 12-months follow-up.
Methods: Single-centre retrospective comparative cohort study comparing outcomes between three groups: phacoemulsification with iStent inject W (phaco-iStent) or OMNI with either 90°-180° (phaco-OG (OMNI and GATT)180) or >180°-360° (phaco-OG360) of GATT. Main outcome measures: Success at 12 months defined as medication-free with either 20% intraocular pressure (IOP) reduction or IOP ≤18 mmHg. Primary outcomes were IOP and number of glaucoma medications. Secondary outcomes included complications and need for further glaucoma surgery. Results: 294 eyes (phaco-iStent, 135; phaco-OG180, 39; phaco-OG360, 120) of 250 patients were included with similar baseline IOP (18 mmHg, p = 0.91) and medications (2.04 vs 1.67 vs 2.01, p = 0.22) across groups. Significant reductions in IOP and number of glaucoma medications were observed across all three groups (p < 0.0014), though no significant differences were found between procedures for any outcome measure. Success rates were 25.2%, 38.5%, and 32.5%, while medication-free rates were 28.1%, 38.5%, and 35.0% for the phaco-iStent, phaco-OG180, and phaco-OG360 groups, respectively, without significant differences. Phaco-OG360 achieved significantly higher rates of medication-free IOP reductions of ≥30% compared to phaco-iStent (p = 0.013) in exploratory analysis. Complications were more frequent in the phaco-OG180 and phaco-OG360 groups compared to the phaco-iStent group, with higher rates of microhyphaema (5.0% and 10.8% vs 0.7%) and layered hyphaema (12.8% and 4.2% vs 0.7%) respectively. One eye in the phaco-OG360 group underwent a trabeculectomy at 6 months.
Conclusions: All procedures significantly reduced IOP and medication burden, with no significant difference in overall success rates. Phaco-iStent has a better safety profile, though phaco-OMNI may provide higher rates of medication-free IOP reduction. Outcomes between 180° and 360° of GATT were similar, suggesting limited additional benefit from extending trabeculotomy. These findings may help guide decision-making in combined phacoemulsification and canal-based minimally invasive glaucoma surgery.
Date
2025-11-28
Type
Article
Subject
Ophthalmology, phacoemulsification
Collections
Citation
Wei Tiong EW, Salam A, Pradeesh N, Masood I. A non-randomised, comparative case series of combined phacoemulsification with iStent inject W and OMNI surgical system. Ophthalmol Glaucoma. 2025 Nov 28:S2589-4196(25)00244-3. doi: 10.1016/j.ogla.2025.11.005. Epub ahead of print.
Journal / Source Title
Ophthalmology Glaucoma
DOI
10.1016/j.ogla.2025.11.005
PMID
Publisher
Elsevier