Glaukos iStent inject® Trabecular Micro-Bypass Implantation Associated with Cataract Surgery in Patients with Coexisting Cataract and Open-Angle Glaucoma or Ocular Hypertension: A Long-Term Study

Abstract

Purpose. To evaluate the long-term efficacy and safety of the iStent inject device (Glaukos Corporation, Laguna Hills, CA) combined with phacoemulsification in patients with coexistent cataract and open-angle glaucoma or ocular hypertension (OHT). Methods. A prospective, uncontrolled, nonrandomized, interventional case series study was conducted in patients with both mild or moderate open-angle glaucoma or OHT and cataract. Patients underwent cataract surgery along with the implant of two iStent inject devices. Outcome measures were intraocular pressure (IOP), topical hypotensive medications required, and best-corrected visual acuity (BCVA). Results. 20 patients were enrolled. Mean follow-up was 47.4 ± 18.46 months. Mean baseline IOP was 19.95 ± 3.71 mmHg with medication and 26 ± 3.11 mmHg after washout. Mean end-follow-up IOP was 16.25 ± 1.99 mmHg, representing an IOP decrease of 36.92%, 9.74 ± 3.14 mmHg (P < 0.001), from baseline washout IOP. The mean number of medications was significantly reduced from 1.3 ± 0.66 to 0.75 ± 0.79 (P = 0.017). 45% of patients were medication-free by the end of follow-up. Mean log⁡MAR BCVA improved significantly from 0.42 ± 0.16 to 0.18 ± 0.16 (P < 0.001). No complications of surgery were observed. Conclusion. The iStent inject device combined with cataract surgery served to significantly reduce both IOP and medication use in the long term in patients with coexistent open-angle glaucoma or ocular hypertension (OHT) and cataract.

Childhood Lensectomy Is Associated with Static and Dynamic Reduction in Schlemm Canal Size

“…With regard to surgical treatments, AS OCT demonstrates an increase in SC size after canaloplasty in adults, correlating with a reduction in IOP. 32 Schlemm canal microstents are implanted in adults with open-angle glaucoma during cataract surgery 33,34 ; their possible usefulness in lensectomy in children is not known.…”

A New Angle on Angle Surgery

“…8 Initial results from a non-randomised, uncontrolled prospective case series of 20 patients, evaluating the efficacy and safety of iStent inject with phacoemulsification were published recently. 9 The study showed a 37% reduction in IOP (9.74±3.14 mmHg, p<0.001) and a reduction in drops from 1.3±0.66 to 0.75±0.79 (p=0.017). The pivotal study evaluating Cypass was the 2-year COMPASS study, carried out by the CyPass Study Group, which evaluated the safety and efficacy of CyPass in patients also undergoing cataract surgery.…”

<p>Combined iStent^® <em>Inject</em> Trabecular Micro-Bypass and Phacoemulsification in Australian Patients with Open-Angle Glaucoma</p>

“…Several studies published over the past 5 years in overseas cohorts suggest that iSI is capable of reducing IOP in the long-term, has a favourable safety profile and, importantly, may reduce reliance on anti-glaucoma medications. [20][21][22][23][24] It may therefore be a valuable therapeutic tool in minimising medication burden and ultimately optimising quality of life also in Australians with POAG and cataract.…”