Trabecular microbypass stent implantation with cataract extraction in pseudoexfoliation glaucoma

Ferguson, Tanner J.; Swan, Russell; Ibach, Mitch; Schweitzer, Justin; Sudhagoni, Ramu; Berdahl, John P.

doi:10.1016/j.jcrs.2017.02.029

Cited by 40 publications

(29 citation statements)

References 15 publications

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“…Although this is not a true “off label” use of the device, the clinical trials leading to its approval did not include eyes with pigmentary or pseudoexfoliative glaucoma. In addition, while not directly comparable, the results of this study are comparable or superior to our published data in eyes with POAG and PXG . At M24 postoperative in those studies, the mean IOP reduction in the POAG and PXG eyes was 3.96 and 5.49 mmHg, respectively.…”

Section: Discussionsupporting

confidence: 73%

“…There was a minimal rate of IOP spikes with only a single case of IOP increase ≥15 mmHg above baseline, no intra‐ or postoperative complications related to the procedure and no eyes required secondary surgery. These results, coupled with our results demonstrated in a pseudoexfoliative glaucoma (PXG) population, further support the device's utility may extend beyond eyes with primary open‐angle glaucoma (POAG). Although this is not a true “off label” use of the device, the clinical trials leading to its approval did not include eyes with pigmentary or pseudoexfoliative glaucoma.…”

Section: Discussionsupporting

confidence: 70%

“…The iStent (Glaukos Corp., San Clemente, California), the first FDA‐approved MIGS device in 2012, is a trabecular micro‐bypass stent that restores physiologic outflow and has been established to be safely and effectively used alone, in combination with other MIGS procedures and with numerous stent placement . Moreover, prior studies have demonstrated its IOP‐lowering capabilities and safety in PXG glaucoma, the most common form of secondary OAG . To date, the literature is limited on the use of MIGS in pigmentary glaucoma and to our knowledge, no study has exclusively investigated the use of the trabecular micro‐bypass stent in combination with cataract surgery in pigmentary glaucoma.…”

Section: Introductionmentioning

confidence: 99%

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

Ferguson

Ibach

Schweitzer

et al. 2019

Clinical Exper Ophthalmology

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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

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Section: Discussionsupporting

confidence: 73%

Section: Discussionsupporting

confidence: 70%

Section: Introductionmentioning

confidence: 99%

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

Ferguson

Ibach

Schweitzer

et al. 2019

Clinical Exper Ophthalmology

Self Cite

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“…To date, this device has amassed a sizable longterm evidence base regarding its safety and performance in eyes with open-angle glaucoma, in settings both with and without cataract surgery. Most studies of the device have assessed outcomes in mild to moderate glaucoma [17][18][19][20][21][22][23][24][25][26][27], but other patient populations increasingly have been the subject of evaluation, such as pseudoexfoliative glaucoma, severe or refractory glaucoma, or newly diagnosed, treatment-naïve glaucoma [28][29][30][31][32][33]. Another growing and relevant area of investigation has been economics outcomes research [34][35][36][37][38][39], which consistently has shown favorable cost-effectiveness of the iStent in various healthcare models around the world.…”

Section: Introductionmentioning

confidence: 99%

Second-Generation Trabecular Micro-Bypass Stents as Standalone Treatment for Glaucoma: A 36-Month Prospective Study

2019

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Introduction: To evaluate long-term outcomes following stand-alone implantation of two second-generation trabecular micro-bypass stents (iStent inject Ò , Glaukos Corp., San Clemente, CA, USA) in eyes with predominantly primary open-angle glaucoma (POAG) and considerable preoperative disease burden. Methods: Eyes with POAG, pseudoexfoliative glaucoma (PXG), appositional narrow-angle glaucoma (NAG, with open-angle configuration in the area of implantation), or secondary glaucoma were included in this prospective, non-randomized, consecutive case series. All eyes underwent ab interno iStent inject implantation as a sole procedure. Assessments through 36 months included IOP, medications, corrected distance visual acuity (CDVA), secondary glaucoma surgeries, and complications and adverse events. Results: Two iStent inject stents were implanted in 44 consecutive eyes (POAG = 38, PXG = 4, appositional NAG = 1, secondary neovascular glaucoma = 1) of 31 patients, and 33 eyes had 36-month follow-up data. Preoperative mean IOP was 25.3 ± 6.0 mmHg on a mean of 2.98 ± 0.88 medications, with 75% of eyes on 3-5 medications, no eyes medication-free, and 50% of eyes with history of prior glaucoma surgery. At 36 months postoperatively, mean IOP reduced by 42% to 14.6 ± 2.0 mmHg (p \ 0.0001) and 87.9% of eyes achieved an IOP reduction of C 20% versus preoperatively. In addition, 97% of eyes reached IOP B 18 mmHg (vs. 9.1% preoperatively; p \ 0.0001) and 70.0% of eyes reached IOP B 15 mmHg (vs. 2.3% preoperatively; p \ 0.0001). Mean medication burden decreased by 82% to 0.55 ± 0.79 (p \ 0.0001), and 61% of eyes became medication-free. All eyes maintained or decreased their 36-month medication burden versus preoperatively. Safety was favorable, including minimal adverse events and stable CDVA through 36 months postoperatively. Conclusion: This real-world cohort of glaucomatous eyes with substantial preoperative disease burden experienced significant, sustained, safe IOP and medication reductions through 36 months following stand-alone iStent inject implantation. Funding: Article processing charges and writing assistance were provided by Glaukos Corp.

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“…Vorübergehende, meist selbstlimitierende Hyphämata sind die noch am meisten in der Literatur beschriebenen Komplikationen [9,34,36]. Sehr selten findet man postoperative IOD-Spitzen [10,14,30] und Stentobstruktionen oder -verlagerungen [8,31,36]…”

Section: Glaukomchirurgie Hat Zunehmend An Bedeutung Gewonnenunclassified

Trabekuläre mikroinvasive Glaukomchirurgie

2018

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The management of glaucoma therapy to reduce intraocular pressure commonly consists of a gradual approach with local monotherapy, combined therapy, laser surgery and finally filtration surgery. The local side effects of glaucoma medications and the lack of adherence and persistence to the medical therapy as well as the complication profile of the established glaucoma surgical techniques justify the introduction of new surgical procedures. Micro-invasive glaucoma surgery (MIGS) is a promising new surgical approach. Microstents can reduce the medication burden and prolong the need for filtration surgery. This review article presents the different trabecular implants (iStent, iStent inject, Hydrus Microstent) in detail and discusses the effectiveness and safety of the procedures based on the currently available data.

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Trabecular microbypass stent implantation with cataract extraction in pseudoexfoliation glaucoma

Abstract: Trabecular microbypass stent implantation during cataract surgery safely and effectively lowered IOP and medication use in patients with mild to severe PXG.

Cited by 40 publications

References 15 publications

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

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

Second-Generation Trabecular Micro-Bypass Stents as Standalone Treatment for Glaucoma: A 36-Month Prospective Study

Trabekuläre mikroinvasive Glaukomchirurgie

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