Efficacy of Streamline Surgical System Alone and in Conjunction with Cataract Extraction for Primary Open-Angle Glaucoma Management in African American Patients
Abstract
Introduction:
The field of microinvasive glaucoma surgery (MIGS) has witnessed substantial growth, encompassing a diverse array of procedures, techniques, and innovations. These interventions collectively aim to enhance physiological aqueous outflow, thereby facilitating intraocular pressure (IOP) control and mitigating the risk of progressive glaucoma and associated irreversible vision loss. Commonly, MIGS procedures involve implant placement. The Streamline Surgical System is a pioneering device that employs an implant-free mechanism by delivering viscoelastic into Schlemm's canal and trabecular meshwork tissue modification, both crucial components of the natural aqueous outflow pathway. Its primary objective is to achieve effective IOP reduction and decrease the risk of progressive glaucomatous damage
Primary open-angle glaucoma, the most prevalent type of glaucoma, is characterized by increased resistance to drainage in the trabecular meshwork, despite the presence of an adequately open drainage angle between the cornea and iris. This condition disproportionately affects the African American population, exhibiting higher incidence rates compared to other ethnic groups, particularly among individuals with a positive family history. In this study, our aim is to evaluate the effectiveness of the Streamline Surgical System in reducing IOP, diminishing the burden of IOP-lowering drops, and enhancing visual outcomes when combined with cataract extraction in a cohort of African American patients diagnosed with primary open-angle glaucoma in mild, moderate and severe stages.
Methods:
A retrospective chart review was conducted, comprising 21 African American patients (31 eyes) who underwent the Streamline Surgical System procedure, with 18 of them undergoing concurrent cataract extraction (28 eyes) at Virginia Eye Consultants in Norfolk, VA by a single surgeon. Statistical analysis was performed to compare pre-operative and post-operative patient data, with a focus on key clinical outcomes, including reduced IOP, decreased reliance on IOP-lowering medications, and improved best-corrected visual acuity (BCVA).
Results:
Paired-samples t-tests were conducted to compare pre-operative and post-operative IOP measurements, as well as the number of IOP-lowering drops used at various intervals (one day, one week, one month, three months, and six months). A significant decrease in post-operative IOP at six months (M=14.00, SD=4.35) was observed compared to the pre-operative state (M=15.90, SD=4.73); t(30)=2.5593, p=0.0485. This reduction in IOP could be attributed to a decrease in the use of IOP- lowering drops (p=0.0158). Furthermore, a paired-samples t-test revealed a statistically significant improvement in post-operative BCVA at six months (p=0.0144) in patients who underwent the Streamline Surgical System in conjunction with cataract extraction.
Conclusion:
The Streamline Surgical System represents an innovative MIGS device that effectively restores physiological aqueous outflow, resulting in significant reductions in IOP and the reliance on IOP-lowering medications among African American patients diagnosed with primary open-angle glaucoma in mild, moderate and severe stages. When performed concurrently with cataract extraction, this approach also leads to improved BCVA, thereby enhancing the overall quality of life for these patients.