Combined iStent trabecular micro-bypass stent implantation and phacoemulsification for coexistent open-angle glaucoma and cataract: a long-term study

Arriola‐Villalobos, Pedro; Martínez-de-la-Casa, J.M.; Díaz-Valle, D.; Fernández-Pérez, Cristina; García–Sánchez, J.; García‐Feijoó, Julián

doi:10.1136/bjophthalmol-2011-300218

Cited by 148 publications

(117 citation statements)

References 21 publications

(22 reference statements)

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“…Our 2-years follow-up 8 fewer hypotensive eye drops compared to pre-op in our study group. The longest reported follow-up period in the literature to date was 5 years in a small prospective case series (n = 19) by Arriola-Villalobos et al 9 The group showed a reduction of IOP by 3 mm Hg (16%) with a drop reduction of 0.5 at the end of a mean follow-up period of 54 months.…”

Section: Discussionmentioning

confidence: 99%

Manchester iStent study: 3-year results and cost analysis

Tan

2016

Eye

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Purpose To evaluate the safety, efficacy, and the cost of combined phacoemulsification and single iStent insertion in open angle glaucoma (OAG) at 3-years follow-up. Methods This was a prospective, uncontrolled, interventional case series. All subjects underwent single iStent implantation combined with cataract surgery by a single surgeon and were followed up over 3 years. Primary outcome measures were the reduction in intraocular pressure (IOP) and number of glaucoma drops at 1, 2, and 3 years. The costs of the procedure vs the cost of continuation of glaucoma drops were calculated and compared in patients who completed 3-years follow-up. Results Forty-one patients were included in the study and thirty-six patients completed 3-years follow-up. Mean pre-op IOP was 21.2 mm Hg on 2.1 medications. Mean IOP was reduced to 15.9 mm Hg on 0.5 drops, 16.1 mm Hg on 1.0 drops, and 17.1 mm Hg (Po0.001) on 1.3 drops (Po0.001) at 1, 2, and 3 years, respectively. The overall cost of combined cataract surgery and iStent was estimated to be £829.32 more in total than conservative management with brand name eye drops over 3 years (£7.70 per patient per year) and £14 176.9 more if generic drops were used. (£131.3 per patient per year). Conclusions Combined phaco-iStent proved to be a safe and effective way of managing patients with OAG over our 3-year follow-up period. The cost-effectiveness of the procedure may vary depending on whether brand name or generic eye drops are used.

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Section: Discussionmentioning

confidence: 99%

Manchester iStent study: 3-year results and cost analysis

Tan

2016

Eye

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“…Numerous studies have assessed outcomes for up to 5 years following implantation of the first U.S. Food and Drug Administration‐approved trabecular micro‐bypass device, the iStent® Trabecular Micro‐Bypass (Glaukos Corporation – San Clemente, CA, USA). These data have demonstrated that implanting single1, 2, 3, 4 or multiple5, 6, 7, 8 first‐generation iStent devices, either with or without cataract surgery, can provide long‐term IOP and medication reduction in patients with mild to moderate glaucoma. In addition, MIGS procedures with these stents have demonstrated a positive benefit‐to‐risk profile in comparison to that of filtering surgeries9 or suprachoroidal stent placement 10, 11…”

Section: Introductionmentioning

confidence: 95%

Implantation of two second‐generation trabecular micro‐bypass stents and topical travoprost in open‐angle glaucoma not controlled on two preoperative medications: 18‐month follow‐up

Berdahl

Voskanyan

Myers

et al. 2017

Clinical Exper Ophthalmology

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ImportanceAdditional data are sought regarding treatment options for glaucoma, a major cause of global blindness.BackgroundThe study assessed outcomes following standalone implantation of two second‐generation trabecular micro‐bypass stents and postoperative topical prostaglandin in eyes with open‐angle glaucoma not controlled on two preoperative medications.DesignThe study design is a prospective, nonrandomized, open‐label study at a tertiary‐care ophthalmology centre.ParticipantsSubjects had open‐angle glaucoma with preoperative intraocular pressure of 18–30 mmHg on two medications, a medication washout phase, and post‐washout intraocular pressure of 22–38 mmHg. All subjects (N = 53) have been followed for 18 months.MethodsOne day following implantation of two second‐generation trabecular micro‐bypass stents, subjects started topical travoprost. Medication washout was repeated at month 12.Main Outcome MeasuresThe main outcome measure was the proportion of eyes with intraocular pressure reduction ≥ 20% versus medicated baseline intraocular pressure with reduction of one medication at 12 months.ResultsAt 12 months, 91% of eyes achieved intraocular pressure reduction ≥ 20% with reduction of one medication. All eyes had intraocular pressure ≤ 18 mmHg with reduction of one medication, and 87% had intraocular pressure ≤ 15 mmHg. Mean intraocular pressure on one medication was ≤ 13.0 mmHg (≥ 34% reduction) through 18 months. Mean post‐washout intraocular pressure at month 13 was 33% lower than preoperative unmedicated intraocular pressure. No adverse events occurred through 18 months.Conclusions and RelevanceIn open‐angle glaucoma eyes on two preoperative medications, treatment with two second‐generation trabecular stents and one postoperative prostaglandin resulted in mean intraocular pressure ≤ 13 mmHg with reduction of one medication, with favourable safety. These findings show the utility of second‐generation trabecular bypass with postoperative prostaglandin in patients with open‐angle glaucoma.

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“…Zu nennen sind hierbei der iStent ® Microbypass (Glaukos Corp., Laguna Hill, USA) sowie der Hydrus™ Microstent (Ivantis Incorp., Irvine, USA). Für den iStent, der bereits in mehreren Studien untersucht wurde, liegen umfangreiche klinische Ergebnisse vor, während beim Hydrus-Stent nur erste Erfahrungen vorliegen, sodass die Beurteilbarkeit noch schwierig ist [11][12][13][14][15][16][17][18][19]. Zumeist wurden die genannten Glaukommikroimplantate im Rahmen einer kombinierten Glaukom-Katarakt-Operation eingesetzt, es gibt jedoch auch Untersuchungen zum solitären Einsatz der Implantate.…”

Section: Intrakanalikuläre Trabekelwerksimplantate Hintergrundunclassified

Stellenwert der Ab-interno-Trabekelchirurgie in der Glaukombehandlung

Dietlein

Lappas

Rosentreter

2014

Klin Monatsbl Augenheilkd

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Ab-interno trabecular surgery does not damage sclera and conjunctiva in glaucoma patients and does not prejudice subsequent anti-glaucomatous filtration or drainage device surgery. As only trabecular resistance is surgically modified, the level of intraocular pressure (IOP) can usually not be reduced in the lower teens. Consequently, incisional ab-interno trabecular surgery is a valuable option in early glaucoma stages with moderate IOP elevation, especially in combination with cataract surgery. Ab-interno trabecular surgery is an insufficient surgical tool in normal pressure glaucoma, but also in glaucoma patients with very high IOP peaks.

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Combined iStent trabecular micro-bypass stent implantation and phacoemulsification for coexistent open-angle glaucoma and cataract: a long-term study

Abstract: Combined cataract surgery and Glaukos iStent implantation seems to be an effective and safe procedure to treat coexistent open-angle glaucoma and cataract.

Cited by 148 publications

References 21 publications

Manchester iStent study: 3-year results and cost analysis

Manchester iStent study: 3-year results and cost analysis

Implantation of two second‐generation trabecular micro‐bypass stents and topical travoprost in open‐angle glaucoma not controlled on two preoperative medications: 18‐month follow‐up

Stellenwert der Ab-interno-Trabekelchirurgie in der Glaukombehandlung

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