As a high-volume refractive cataract surgeon, what I value in a MIGS procedure or device is not only efficacy for IOP control, but also tremendous safety and no interference with early postoperative visual outcomes. In my experience, iStent inject^® fulfills all of these requirements.

My initial 76 cases of cataract surgery plus iStent inject implantation in patients with mild-to-moderate glaucoma have resulted in statistically and clinically meaningful reduction in IOP and medication use with no safety issues (see Table 1).

I haven’t observed any problems, such as hyphema, hypotony, or myopic shift that have been reported with other MIGS devices. Among patients who have been followed postoperatively for one year (n=9), IOP has been reduced by 21 to 28% on average and medication use has declined from a mean of 1.5±0.9 preoperatively to a mean of 0.2±0.4 (p<0.05). I will continue to monitor and track all of my patients as they progress to longer-term follow up, though I’ve been encouraged by my results to date.

Investigator Insight: I found iStent inject to involve a straightforward learning curve with the appropriate training and attention to detail. Nevertheless, visualization is everything in MIGS. Therefore, to avoid nicking limbal blood vessels during cataract/iStent inject surgery, I’m careful to make my cataract incision in clear, not near-clear, cornea. I also change my body position, rotating the microscope slightly, for placing the second stent, which requires a different hand position than placing the first stent.

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.

BLAKE K. WILLIAMSON, MD, MPH, MS, is a third-generation ophthalmologist at Williamson Eye Center in Louisiana where he specializes in high-volume refractive cataract surgery, laser vision correction,and MIGS.