Manchester <scp>iStent</scp> study: early results from a prospective <scp>UK</scp> case series

Patel, Ilesh; Klerk, Timothy A de; Au, Leon

doi:10.1111/ceo.12098

Cited by 57 publications

(34 citation statements)

References 21 publications

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“…This is consistent with previous studies that have suggested that the IOPlowering effect after iStent/CEIOL surgery was achieved by 3 months and persisted through at least 6 to 12 months postoperatively. 2,12 We also found that patients who were receiving 3 or more glaucoma medications preoperatively were more likely than those receiving only 1 medication at baseline to achieve postoperative glaucoma medication reduction. Several studies have reported that patients receiving more glaucoma medications or more complex medication regimens may have greater difficulty with medication adherence.…”

Section: Discussionmentioning

confidence: 63%

Ocular Antihypertensive Medication Use After iStent Implantation Concurrent With Cataract Surgery vs Cataract Surgery Alone in a Large US Health Care Claims Database

et al. 2019

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The iStent Trabecular Micro-Bypass (Glaukos Corporation) is a minimally invasive glaucoma implant used in conjunction with cataract surgery to lower intraocular pressure. OBJECTIVE To determine whether implantation of the iStent concurrent with cataract surgery is associated with reduced use of ocular antihypertensive medications in a US health care claims database. DESIGN, SETTING, AND PARTICIPANTS Retrospective, observational longitudinal cohort study of individuals enrolled in a US managed care network who underwent iStent implantation with cataract surgery (iStent/CEIOL) from 2012 to 2016 (n = 1509 bilateral and n = 1462 unilateral surgery). A control group of individuals who underwent bilateral cataract surgery only (CEIOL) were matched 1:1 to patients undergoing bilateral iStent/CEIOL on baseline demographic and clinical factors. Data were analyzed between November 1, 2017, and January 31, 2018. MAIN OUTCOMES AND MEASURES The number of topical ocular antihypertensive agents used postoperatively by patients undergoing iStent/CEIOL compared with baseline and with matched CEIOL control individuals, and hazard ratios with 95% confidence intervals for sustained reduced use of at least 1 topical ocular antihypertensive agent postoperatively. RESULTS Of the 2971 eligible enrollees, mean age at first surgery was 74.3 years, and 1659 (55.8%) were women. Patients undergoing iStent/CEIOL had diagnoses that included primary open-angle glaucoma (n = 2329; 78.4%), narrow angles (n = 381; 12.8%), and secondary glaucomas (n = 261; 8.8%). At baseline, 1223 (41.2%) were receiving no topical glaucoma agents; 876 (29.5%), 437 (14.7%), and 435 (14.6%) were receiving 1, 2, or at least 3 agents, respectively. Although only 678 persons (22.8%) completed at least 2 years of postoperative follow-up, the proportion of patients receiving no drops increased postoperatively (64.7%, 20-24 months, P < .001, χ 2). Patients receiving at least 1 topical agent at baseline had mean reduction of 1.01 and 0.61 medications used at 20 to 24 months with bilateral or unilateral surgery, respectively (both P < .001, paired t). Sustained reduction in glaucoma medication use was more likely in patients receiving at least 3 vs 1 medication at baseline (hazard ratio, 1.68; 95% CI, 1.36-2.09). Compared with matched control individuals undergoing CEIOL, patients undergoing bilateral iStent/CEIOL had a greater mean reduction in drops used (0.99 vs 0.49; postoperative month 20-24; P < .001; paired t) and a higher proportion receiving no drops postoperatively (73.5% vs 55.3%, postoperative month 20-24; P < .001; χ 2). CONCLUSIONS AND RELEVANCE Implantation of the iStent trabecular micro-bypass stent concurrent with cataract surgery was associated with moderately reduced use of topical ocular antihypertensive medication. Reduction in the use of glaucoma medications may lessen the burden of medication adverse effects and promote better adherence.

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Section: Discussionmentioning

confidence: 63%

Ocular Antihypertensive Medication Use After iStent Implantation Concurrent With Cataract Surgery vs Cataract Surgery Alone in a Large US Health Care Claims Database

et al. 2019

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“…Stent or tube malposition or obstruction has been reported in 4-18.0% of cases in iStents, 2,3,17 8.8% in Cypass, 12 and 3.0% in Baerveldt tube. 18 Only one patient (2.6%) developed hyphaema in our cohort, compared to 2.3% in iStent, 19 2.0% in Baerveldt tube, 18 and 6-24.6% in the trabeculectomy studies. 7,16,18 As the IOP tends to be the lowest immediately post surgery, hyphaema can occur due to the lack of an IOP tamponade.…”

Section: Discussionmentioning

confidence: 54%

One-year result of XEN45 implant for glaucoma: efficacy, safety, and postoperative management

Tan

Walkden

2017

Eye

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PurposeTo report the efficacy, safety profile, and postoperative management of XEN45 implant at 12-month follow-up.Patients and methodsThis was a retrospective, non-randomised interventional case series involving patients who underwent XEN45 implantation by a single, experienced glaucoma specialist in a tertiary centre. Primary outcome measures were the intraocular pressure (IOP) and the number of medications at 1-year follow-up visit. Two IOP criteria were chosen to measure success: IOP ≤21 mm Hg and ≥20% reduction from baseline (criteria one); and IOP ≤15 mm Hg and ≥30% reduction from baseline (criteria two).ResultsAll 39 eyes completed 1-year follow-up. The mean preoperative IOP was 24.9±7.8 mm Hg on three drops, which reduced to 14.5±3.4 mm Hg at month 12 (P<0.005) on 0.7 drops (P<0.005). On the basis of criteria one, the cumulative probability of success at 1 year was 87.0% without medication and 92.0% with medication. On the basis of criteria two, cumulative probability of success was 62.0% without medication and 64.0% with medication. Bleb intervention with a median of 2 (range 1-4) was required for 51.3% of eyes. Implant was obstructed by iris tissue in three eyes (7.7%); one eye (2.6%) developed hyphaema; eight eyes (20.5%) had numerical hypotony (IOP≤5 mm Hg) at day 1, of which all spontaneously resolved by week 4 apart from one eye.ConclusionsThe XEN45 implant proved to be an effective treatment with a good safety profile at 1-year follow-up period. The high rate of postoperative bleb intervention does not make XEN45 a 'fit-and-forget' procedure and therefore the procedure should ideally be performed by surgeons experienced in bleb management.

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“…iStents and Trabectome surgeries are often combined with cataract extraction to improve vision and lower pressure. Complications from these new procedures are significantly lower than conventional filtration surgeries; hyphema appears to be the most common risk attached to stent devices and Trabectome within the initial postoperative period with no long-term consequence 6 8 9. Patients can now benefit from an effective, minimally invasive glaucoma procedure with fast visual improvement and the low complication rate that we have all enjoyed for years with small incision phacoemulsification.…”

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confidence: 99%

Are newer surgical interventions for glaucoma making a difference?

2013

Br J Ophthalmol

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Manchester iStent study: early results from a prospective UK case series

Cited by 57 publications

References 21 publications

Ocular Antihypertensive Medication Use After iStent Implantation Concurrent With Cataract Surgery vs Cataract Surgery Alone in a Large US Health Care Claims Database

Ocular Antihypertensive Medication Use After iStent Implantation Concurrent With Cataract Surgery vs Cataract Surgery Alone in a Large US Health Care Claims Database

One-year result of XEN45 implant for glaucoma: efficacy, safety, and postoperative management

Are newer surgical interventions for glaucoma making a difference?

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