In her ASCRS 2026 presentation, "Combining MIGS With Implant Lowers IOP in Glaucoma," Lisa K. Feulner, MD, PhD, chief medical editor of Ophthalmology Management and chief medical officer of Advanced Eye Care & Aesthetics, discussed real-world outcomes of combining trabecular microbypass stents and cataract surgery with or without an intracameral travoprost implant. Dr. Feulner began her presentation by explaining that topical medications are not ideal for slowing glaucoma progression.
“Topical drops often fail to halt glaucoma progression due to compliance issues, side effects, and regimen complexity,” she explained. “Interventional glaucoma offers a proactive approach to improve outcomes and patient quality of life.”
Real-World Outcomes
Dr. Feulner presented her findings from a retrospective, single-center, consecutive case series she conducted in patients with open-angle glaucoma. Procedures included iStent Infinite (Glaukos)—an implantable device intended to reduce the intraocular pressure (IOP) of the eye—with cataract surgery, with or without the iDose TR (Glaukos)—an intracameral, sustained-release travoprost implant. Outcomes were tracked over 3 to 6 months.
Dr. Feulner presented data comparing intraocular IOP before and after surgery, as well as the number of topical IOP-lowering medications and any safety issues. Patient demographics and baseline glaucoma characteristics were similar between the 2 groups. The analysis included 49 patients, with 24 patients receiving iStent Infinite and cataract surgery and 25 patients receiving iStent Infinite and iDose TR and cataract surgery. Mean patient age was 74.6 years in the iStent Infinite and cataract surgery group, and 77.1 years in the combined iStent Infinite, iDose TR and cataract surgery group, with corresponding ranges of 58 to 87 years and 68 to 90 years.
Results
Dr. Feulner noted that there was a statistically significant reduction in IOP (1.9 mmHg) as well as topical medications following cataract surgery with the iStent Infinite and cataract surgery group. She also pointed out that 29% of patients had IOP less than 10 following surgery vs 8% prior to surgery, and 54% of eyes were free of topical IOP-lowering meds vs 8% prior to surgery. In the group receiving iStent Infinite with iDose TR and cataract surgery, there was a statistically significant reduction in IOP (2.6 mmHg) as well as topical medications. In that second group, 44% of patients had IOP less than 10 mmHg following surgery vs 12% prior to surgery, and 88% of eyes were free of topical IOP-lowering meds vs 26% prior to surgery. There were no treatment-related adverse events reported, noted Dr. Feulner. Both groups achieved significant IOP reductions.
What was notable, Dr. Feulner said, was the addition of iDose TR increasing the proportion of eyes reaching less than 10 mmHg and medication-free status. “Both surgical approaches reduced the need for topical medications, lowering the treatment burden, and potentially improving adherence,” she explained.
Safety
In the iStent Infinite and cataract surgery group, one 72-year-old patient with moderate primary open-angle glaucoma (POAG) on latanoprost+dorzolamide-timolol, and with a previous trabeculectomy was referred out for a second trabeculectomy at 6 months post procedure. In the iStent Infinite and iDose TR and cataract surgery group, one 81-year-old patient with severe POAG was referred out for a trabeculectomy 1 month post procedure, and was excluded from analysis due to a lack of follow-up data.
“Combining trabecular microbypass stents with cataract surgery, with or without iDose TR, significantly lowers IOP and reduces topical medication needs,” concluded Dr. Feulner. “The addition of iDose TR increased the proportion of eyes reaching <10 mmHg and medication-free status. This represents a proactive approach that can improve both glaucoma management and patient quality of life.” OM