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Incidence and risk factors of steroid-induced ocular hypertension following combined cataract surgery with trabecular micro bypass stent implantation.

Kenan Bachour, Mikael Bernier, Georges M Durr

Objective: To determine the incidence and risk factors of a steroid response in eyes undergoing combined cataract surgery with trabecular microbypass stent implantation; iStent (Glaukos Inc., San Clemente) or Hydrus (Alcon Laboratories Inc., Fort Worth).

Design: This retrospective descriptive cohort study reports 3-month outcomes of 100 consecutive eyes (100 patients) that underwent trabecular microbypass stenting (iStent or Hydrus) between September 2019 and March 2022.

Methods: All patients received topical dexamethasone 0.1% postoperatively and all glaucoma medications were stopped. A steroid response was defined as a rise in Intra Ocular Pressure (IOP) of ≥ 5 mmHg above baseline beginning at least 3 days postoperatively, with no other obvious explanation for the pressure rise. A steroid response was graded as mild if the IOP increase was ≥ 5 but <10 mmHg, moderate if ≥ 10 but <20 mmHg, and severe if ≥ 20 mmHg. Moderate and severe responses were considered clinically significant.

Results: 46 eyes had iStents and 54 eyes had Hydrus implants. A steroid response developed in 41 eyes (19 mild, 17 moderate and 5 severe). Significant steroid responses developed in 13% of eyes following iStent (N=6), and in 30% eyes following Hydrus (N=16). Younger age (P=0.003) and a higher number of preoperative glaucoma medications (P=0.002) were predictors of a significant steroid response on multivariate analysis.

Conclusion: A significant steroid response developed in 22% following cataract surgery combined with trabecular stent implantation. Younger age and a higher number of glaucoma medications were predictors of a steroid response.