Inadvertent implantation of an iStent in the supraciliary space identified by ultrasound biomicroscopy

Mantravadi, Avinash V.; Lin, Clarissa; Kinariwala, Bhumi; Waisbourd, Michael

doi:10.1016/j.jcjo.2016.08.018

Cited by 3 publications

(3 citation statements)

References 4 publications

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“…Insertion of the iStent inject stents does not require the use of additional incisions and wound stretch during the stent insertion process is nominal, minimising the risk of increasing surgically induced corneal change. 10 With an excellent safety profile, significant malposition of the stent is unlikely and injection of the device into the supraciliary space is rare, limited within the literature to a single case report only 24,25 Furthermore, the risk of iatrogenic damage to the zonules with subsequent impact upon IOL positioning remains largely theoretical. 24 The potential impact of the disease upon IOL power calculations and outcomes may be generalised to all glaucoma patients.…”

Section: Discussionmentioning

confidence: 99%

“…10 With an excellent safety profile, significant malposition of the stent is unlikely and injection of the device into the supraciliary space is rare, limited within the literature to a single case report only 24,25 Furthermore, the risk of iatrogenic damage to the zonules with subsequent impact upon IOL positioning remains largely theoretical. 24 The potential impact of the disease upon IOL power calculations and outcomes may be generalised to all glaucoma patients. Preoperatively, reduced vision due to glaucomatous changes may impact the patient's ability to accurately fixate through biometry and related assessments.…”

Section: Discussionmentioning

confidence: 99%

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Refractive Outcomes After Trabecular Micro-Bypass Stents (iStent Inject) with Cataract Extraction in Open-Angle Glaucoma

Ioannidis

Töteberg‐Harms

Hamann

et al. 2020

OPTH

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Purpose: Simultaneous cataract and glaucoma surgery has traditionally been challenging for the anterior segment surgeon. The introduction of minimally invasive glaucoma surgery (MIGS) in conjunction with cataract surgery appears safe and effective in lowering intraocular pressure. Although a significant visual impact leading from the combined procedure is unexpected, we aim to describe the refractive outcomes in a cohort of patients undergoing simultaneous cataract removal and iStent inject and discuss the potential implications of combined surgery in patients with co-existent glaucoma. Patients and Methods: This is a retrospective consecutive case series inclusive of patients undergoing combined femtosecond laser-assisted cataract surgery and the insertion of two trabecular micro-bypass stents (iStent inject). Visual acuity, refraction and astigmatic vector analysis were collated and analysed from the preoperative and 4 weeks postoperative visits. Results: One hundred and six eyes of 89 patients from 2 surgeons were included in the original cohort. The mean absolute difference from target refraction was 0.36 ± 0.25D. 73.9% of eyes were within ± 0.5D of the refractive target and 98.9% of eyes were within ± 1.00D. 73.8% of eyes had 0.5D or less residual refractive astigmatism following the procedure. Conclusion: We present a novel cohort of glaucoma patients undergoing combined trabecular micro-bypass stents (iStent inject) and cataract surgery achieving excellent refractive outcomes. The results of this study indicate that this second-generation device is refractively neutral.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Refractive Outcomes After Trabecular Micro-Bypass Stents (iStent Inject) with Cataract Extraction in Open-Angle Glaucoma

Ioannidis

Töteberg‐Harms

Hamann

et al. 2020

OPTH

View full text Add to dashboard Cite

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“…There were no associations with anticoagulants, stent malposition, or angle abnormalities, and the episodes were thought to be related to ocular pressure from sleeping position that was reduced upon waking. Regarding implantation, Mantravadi et al reported a case of inadvertent implantation of an iStent into the supracilliary space [17]. An iridodialysis cleft was created at the time of attempted stent repositioning.…”

Section: Avoiding Complications and Surgical Pearlsmentioning

confidence: 99%

iStent: Trabecular Micro-Bypass Stent

Larsen

Samuelson

2020

Minimally Invasive Glaucoma Surgery

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Within the class of procedures termed minimally invasive glaucoma surgery (MIGS), the iStent Trabecular Micro-Bypass Stent (Glaukos Corporation, San Clemente, CA, USA) is an intraocular implant that resides within Schlemm’s canal and allows for direct bypass of the trabecular meshwork by aqueous fluid. The acceptance of MIGS is growing due to its role in lowering intraocular pressure in mild-to-moderate glaucoma combined with its favorable safety profile. With transscleral glaucoma-filtering surgery, there is an increased potential for significant complications including hypotony, suprachoroidal hemorrhage, and long-term risk of endophthalmitis. By contrast, the iStent minimizes these risks and has demonstrated similarities to cataract surgery in terms of associated complications. Multiple publications have described both the safety and efficacy of the implant. These studies are reviewed in addition to a description of the implantation technique and postoperative management pearls. The second-generation model, the iStent inject, may ease implantation and the use of multiple stents may potentially play a role in more advanced disease.

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Anterior segment imaging in minimally invasive glaucoma surgery – A systematic review

Kan

Betzler

Lim

et al. 2021

Acta Ophthalmologica

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Minimally invasive glaucoma surgery (MIGS) has grown in popularity over the past decade. This systematic review explores the peri‐operative and intraoperative application of anterior segment imaging to maximize the efficacy and safety of MIGS. A review of the PubMed, EMBASE and CINAHL databases was conducted, with inclusion criteria restricted to MIGS that had received United States Food and Drug Administration (FDA) premarket approval, FDA 510(K) premarket notification, or were listed as a class 1 device exempt from FDA approval or notification. 21 manuscripts from 21 unique studies were identified pertaining to MIGS devices including the XEN Gel Stent, Trabectome, iStent Inject, 1st‐generation iStent and the Kahook Dual Blade (KDB). Anterior segment imaging modalities included anterior segment optical coherence tomography (AS‐OCT), ultrasound biomicroscopy (UBM), aqueous angiography, OCT volumetric scans and in vivo confocal microscopy. Identification and evaluation of aqueous outflow pathways before and after MIGS have potential for improving patient preoperative patient selection and postoperative outcomes. Intraoperative imaging potentially provides the resolution needed for good visualization of angle anatomy and accurate evaluation of surgical endpoints in angle‐based MIGS. Anterior segment imaging has been used to identify procedural complications, provide objective information on implant location in relation to surrounding anatomy, assess the post‐implantation structural impact of MIGS devices and manage bleb failure and scarring. Technical difficulties in incorporating imaging modalities into the surgical microscope, variable quality of images and optical interference from ocular structures or surgical instruments are remaining barriers, which discourage the widespread clinical use of this technology.

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Inadvertent implantation of an iStent in the supraciliary space identified by ultrasound biomicroscopy

Cited by 3 publications

References 4 publications

<p>Refractive Outcomes After Trabecular Micro-Bypass Stents (iStent <em>Inject</em>) with Cataract Extraction in Open-Angle Glaucoma</p>

<p>Refractive Outcomes After Trabecular Micro-Bypass Stents (iStent <em>Inject</em>) with Cataract Extraction in Open-Angle Glaucoma</p>

iStent: Trabecular Micro-Bypass Stent

Anterior segment imaging in minimally invasive glaucoma surgery – A systematic review

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