When considering adoption of microinvasive glaucoma surgery (MIGS), surgeons prefer a safe and convenient procedure that delivers long-term benefits for patients, i.e., IOP control with less reliance on medications and the cost and ocular surface health benefits that go along with that.

My early experience with iStent inject^® supports its use as a treatment for mild-to-moderate glaucoma in patients undergoing cataract surgery. With training and proper attention to detail, implantation of the two stents that comprise the iStent inject system is a procedure most surgeons can adopt, and my consecutive case series to date demonstrates favorable reduction in IOP and medication use (see Table 1). Among the 24 eyes that have been evaluated at 3 months after surgery, 62.5% have IOP ≤15 mmHg, and IOP is controlled with a mean of 0.6 medications compared with 1.0 medications preoperatively. Safety at 3 months is similar to cataract surgery alone.

Investigator Insight: In trabecular bypass MIGS, the view into the iridocorneal angle is crucial and must be maintained under high magnification. The key to maintaining a good view while placing the iStent inject injector into the eye and injecting the stents is to maintain the anterior chamber. The best way to accomplish this is to prevent viscoelastic egress by not pressing down on the wound or on the gonio lens.

The postoperative course with iStent inject is uneventful in my experience. I have my patients follow the same antibiotic and steroid drop regimen that I do with cataract surgery alone. While some surgeons prefer to keep patients on their glaucoma drops for a month or more after cataract/iStent inject surgery, I have my patients discontinue their glaucoma medications on post-op day one, so I can evaluate whether the stents are working as expected. As a glaucoma specialist, I’m comfortable following patients closely to monitor for potential IOP spikes, although this hasn’t been a problem thus far.

SAHAR BEDROOD, MD, PHD, is a partner in Acuity Eye Group in California and an assistant professor of clinical ophthalmology at the USC Roski Eye Institute.