To date, I’ve implanted iStent inject^® in conjunction with cataract surgery for 84 patients with mild-to-moderate glaucoma. My consecutive case series is demonstrating promising initial evidence of significant reduction of IOP, reduction in medication use, and favorable safety (see Table 1).

Among all eyes, including 21 that have reached the 6-month follow-up point, IOP has been reduced by 26% on average, and 57.1% of eyes are medication-free. Results are consistently positive regardless of length of follow-up.

Notably, the least dramatic decline in IOP is tending to occur from surgery to 1 month—likely because no medication washout was done—but the lowest IOPs achieved to date are seen at 6 months after surgery. In my practice, we don’t necessarily discontinue glaucoma medications immediately after surgery. Depending on the patient, we may wait 2 to 3 months to try to reduce the number of medications.

In the eyes I’ve treated with iStent inject, no peripheral anterior synechiae, inflammatory response, stent obstruction, IOP >30 mmHg, hypotony, hemorrhage, or significant hyphema has occurred. All postoperative adverse effects were limited and resolved without sequelae. In all patients, postoperative visual acuity (no evidence of refractive surprise), cup-to-disc ratio, and visual field have remained stable.

Investigator Insight: The technique for implanting iStent inject is different than for the original iStent, so surgeons should take a step back to familiarize themselves with the procedure. Implantation of the first-generation iStent required somewhat of a sweeping motion for placement in the trabecular meshwork, while iStent inject implantation is more dart- or push-pin-like. Visualization and working in the iridocorneal angle remain critically important to being successful with the device.

The iStent inject stents should be placed 2 to 3 clock hours apart in different quadrants. My personal preference is to deploy a stent to my right first, before I deploy a stent to the left, because that one is more directly across from the entry wound. For me, the second stent feels more natural.

EVA LIANG, MD, FACS, is the founder and medical director of Center For Sight - Las Vegas, a comprehensive eyecare practice serving patients in three locations in southern Nevada.