Ab interno minimally invasive glaucoma surgery combined with cataract surgery and cataract surgery alone: IRIS® registry study

Describe real-world characteristics and outcomes in patients undergoing Food and Drug Administration (FDA) approved/cleared ab interno Minimally Invasive Glaucoma Surgery (MIGS) combined with cataract surgery or cataract surgery alone. An observational, retrospective study of glaucomatous disease treated with MIGS (OMNI® Surgical System, Hydrus®, iStent Inject®) combined with cataract surgery or cataract surgery alone, documented in the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) The study period was between 07/01/2017 and 12/31/2022. Eligible patients were identified via Current Procedural Terminology (CPT) codes coupled with electronic health records. Outcomes included intraocular pressure (IOP) and IOP-lowering medication class usage over 24 months stratified by baseline IOP (≤18 and >18 mmHg). Bonferroni testing (p<0.0125) were applied. Glaucomatous disease was identified for 77,391 (OMNI: 428, Hydrus: 1,435, iStent Inject: 4,769, cataract surgery alone: 70,759) patients (109,745 eyes). For patients with a baseline IOP >18 mmHg, significant (p<0.001) change in IOP (OMNI -6.64 [SD 7.59], Hydrus -5.71 [6.30], iStent Inject -4.96 [7.30], cataract surgery alone -5.55 [6.41]) and medication usage (OMNI -1.34 [1.48], Hydrus -1.20 [1.18], iStent Inject -0.86 [1.10], cataract surgery alone -0.67 [1.10]) were observed at 24 months. In the baseline IOP ≤18 mmHg subgroup, all cohorts showed significant medication reductions (p<0.001), with no change in IOP. MIGS combined with cataract surgery and cataract surgery alone resulted in significant and sustained IOP (baseline IOP >18mmHg) and medication reductions both IOP subgroups. As MIGS procedures lead to non-equivalent results, further research will define the role of each in patient subpopulations.