Advertisement

PentaVision

Ophthalmology Management

Article

Early Results of Second-Generation Trabecular Micro-Bypass Stents with Cataract Surgery in a Real-World Setting

Ophthalmology Management March 1, 2020

Clinical trials and a large body of peer-reviewed literature based on real-world surgeon experience support that patients with mild-to-moderate glaucoma who receive an iStent inject® at the time of cataract surgery have better long-term intraocular pressure (IOP) control and may reduce their dependence on medications.1,2 Currently, I’m closely evaluating my results with the device.

According to my retrospective chart review of the 117 eyes with mild-to-moderate glaucoma for which I combined cataract surgery with iStent inject between August 2018 and February 2019, iStent inject clearly demonstrates a favorable benefit-to-risk ratio (see Table 1).

TABLE 1
RESULTS - KIM
(n=51 of 117 with 6-month follow-up)
Pre-Op Post-Op
Mean IOP 16.0±4.1 mmHg 13.8 mmHg
Reduction in mean IOP 13.8% (p=.002)
Mean # of medications 0.9±0.9 (0-4) 0.6
Reduction in mean # of medications 33% (P<0.001)
Eyes with IOP ≤ 15 mmHg 47.9% 77%

Patients, including the consistent cohort of 51 eyes with 6-month follow-up, achieved statistically and clinically significant reductions in IOP and medication use with no intraoperative complications or device-related adverse events.

Interestingly, a significant response was achieved in eyes with relatively low preoperative IOP and medication use as well as among the 30.8% of eyes that had previously undergone an IOP-lowering laser procedure or glaucoma surgery.

Investigator Insight: iStent inject helps me reach my main goals for my glaucoma patients—control IOP as tightly as possible, prevent progression, and avoid incisional surgery—with less reliance on their compliance with medications. We’re learning that early intervention and taking compliance/adherence out of patients’ hands, as was shown in the LiGHT study,9 may help to reduce the likelihood of incisional surgery in the future.

REFERENCES

  1. Craven ER, et al.; iStent Study Group. J Cataract Refract Surg. 2012;38(8):1339-1345;
  2. Neuhann TH, et al. J Cataract Refract Surg. 2019;45(3):312-320;
  3. Samuelson TW, et al. Ophthalmology. 2019;126:811-821;
  4. Huang AS, et al. Ophthalmology Glaucoma. 2019;2(1):11-21;
  5. Huang AS, et al. Invest Ophthalmol Vis Sci. 2016;57(11):4558-4565;
  6. Clement CI, et al. Clin Ophthalmol. 2019;13:491-499;
  7. Hengerer FH. Presented at the 2018 annual meeting of the American Society of Cataract and Refractive Surgery. Washington, D.C.;
  8. Arriola-Villalobos P, et al. J Ophthalmology. 2016;2016:1056573;
  9. Gazzard G, et al. Lancet. 2019;393(10180):1505-1516.
JOSHUA W. KIM, MD, is a cataract surgeon and glaucoma specialist at Center For Sight in Florida. He has co-authored numerous research papers, serves on various advisory boards, and is frequently a principal investigator in clinical trials of new glaucoma therapies.

JOSHUA W. KIM, MD, is a cataract surgeon and glaucoma specialist at Center For Sight in Florida. He has co-authored numerous research papers, serves on various advisory boards, and is frequently a principal investigator in clinical trials of new glaucoma therapies.

What to Read Next