Trabecular micro‐bypass stent implantation with cataract extraction in pigmentary glaucoma

Abstract

Importance: Use of the trabecular micro-bypass stent with cataract surgery is well established to be safe and effective in primary open-angle glaucoma. This is the first study to exclusively evaluate use of the device in pigmentary glaucoma. Background: This study aimed to investigate the safety and efficacy of a trabecular micro-bypass stent in combination with cataract surgery in pigmentary glaucoma. Design: Retrospective, consecutive case series. Participants: Twenty-four eyes of 12 patients with pigmentary glaucoma implanted with one trabecular micro-bypass stent with concomitant cataract surgery. Methods: Baseline data was collected and compared to the following postoperative time points: 1 day, 1 week, 1 month out to 36 months (M36) after the procedure. Main Outcome Measures: These included intraocular pressure (IOP), number of glaucoma medications and need for additional surgery. Results: At M36 there was a 25% reduction in IOP to 14.68 ± 3.0 (P < .01) from 19.50 ± 6.7 mmHg at baseline. The mean number of glaucoma medications was 0.75 ± 1.0 prior to the surgery and 0.59 ± 0.6 (P > .05) at 36 M. At the 36 M time-point, 95% of eyes had IOP ≤ 18 mmHg and 68% of eyes were ≤ 15 mmHg. No eyes underwent a secondary glaucoma procedure. Conclusions and Relevance: The insertion of a single trabecular micro-bypass stent in combination with cataract surgery effectively provides a sustained reduction in IOP up to 3 years after surgery in patients with pigmentary glaucoma. The safety profile is favourable with low rate of IOP spikes and no patients requiring additional surgery. K E Y W O R D S iStent, MIGS, pigmentary glaucoma, secondary open-angle glaucoma, trabecular micro-bypass stent

<p>iStent Trabecular Micro-Bypass Stent Implantation with Cataract Surgery in a Japanese Glaucoma Population</p>

“…To date, the safety and performance of iStent trabecular micro-bypass have been established by a breadth of studies evaluating the device, including in standalone implantation or in combination with cataract surgery or other MIGS procedures, in both single-and multiple-stent usage, in populations with various levels of disease severity, and in various subtypes of glaucoma and ocular hypertension. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] The stent has been widely adopted and studied by surgeons around the world. 43 However, iStent outcomes have not been as closely examined in Japanese populations.…”

Prospective Interventional Cohort Study of Ocular Surface Disease Changes in Eyes After Trabecular Micro-Bypass Stent(s) Implantation (iStent or iStent inject) with Phacoemulsification

“…Fechtner et al also reported incrementally higher OSDI scores in patients using more glaucoma medications, with mean OSDI scores of 12.9, 16.7, and 19.4 in eyes on one, two, and three glaucoma medications, respectively [9]. Alongside such studies correlating medications with ocular surface disease, the medication reductions consistently observed after stent implantation also are well known and widely documented [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. Thus, it stands to reason that stent implantation would result in ocular surface improvement.…”

“…1a) is a 12-item subjective questionnaire designed to assess a patient's symptoms related to chronic dry eye, its severity, and its impact on ability to function [32]. OSDI scores range from 0 to 100, with severity defined as normal (0-12), mild (13)(14)(15)(16)(17)(18)(19)(20)(21)(22), moderate (23)(24)(25)(26)(27)(28)(29)(30)(31)(32), and severe (33-100). The Oxford Schema (Fig.…”

“…Both micro-scale devices are designed to create a patent pathway through the diseased trabecular meshwork into Schlemm's canal, thereby increasing aqueous humor outflow from the anterior chamber and decreasing intraocular pressure (IOP). Stent implantation has been examined in the setting of cataract surgery or as a standalone procedure, in varying glaucoma severities ranging from glaucoma suspect to refractory glaucoma, and in various glaucoma subtypes (e.g., pseudoexfoliative, pigmentary, normal-tension) as well as in primary open-angle glaucoma (POAG) [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. In both long-and short-term followup, stent implantation has consistently demonstrated substantial reductions in IOP and medication burden.…”

iStent inject trabecular microbypass stent implantation with cataract extraction in open-angle glaucoma: early clinical experience

“…The data from this present study comes from a single surgeon (J.P.B.) with extensive experience with the firstgeneration iStent device [7,28,29] ,which likely mitigated any early learning curve with the second-generation device. While it cannot be directly compared, the IOP-lowering results at 6 months in this present study are consistent or superior to what was reported with our experience in eyes with OAG with the first-generation device in combination with cataract surgery, which demonstrated a mean reduction of 3.7 mmHg at 6 months postoperative in the consistent cohort [30], compared to the 4.6 mmHg reduction noted in this study's consistent cohort.…”