Free Papers

The iStent Inject® is an effective tool in the management of open-angle glaucoma by the non-glaucoma-specialist ophthalmic surgeon

Free Paper Details

First Author: M.Shamdas UK

Co Author(s):    M. Shamdas   A. Rowlands   B. Ramasamy              

Abstract Details

Purpose:

This retrospective study evaluates real-world outcomes of the iStent Inject® (Glaukos Corporation, California, USA) trabecular micro-bypass system both as an adjunct to cataract surgery and as a stand-alone procedure in the management of open angle glaucoma. This study specifically considers outcomes achieved by a non-glaucoma-specialist ophthalmic surgeon and evaluates clinical effectiveness, adverse events and learning curve aspects.

Setting:

Single centre, district-general ophthalmic unit, within the National Health Service in the UK.

Methods:

We evaluate outcomes of consecutive eyes implanted with the iStent Inject® either combined with cataract surgery or as a standalone procedure, between October 2018 and July 2019. Included patients were the first cohort operated on by a single non-glaucoma-specialist ophthalmic surgeon (BR). Eligible patients had open-angle glaucoma and the need for IOP and/ or medical treatment reduction. Eyes with missing or unavailable data and significant co-existing ocular conditions were excluded. Eligible cases were identified through an Electronic Patient Record. Collected data included pre- and post- operative visual acuity, intraocular pressure, medication and any recorded adverse events.

Results:

39 eyes were included, of which 34 underwent combined iStent Inject® with cataract surgery and 5 underwent standalone procedures. Mean time to follow-up was 6.3 months. Mean reduction in IOP was 2.8mmHg (17.2mmHg pre-operatively versus 14.4mmHg post-operatively). There was a statistically significant reduction in mean number of topical anti-glaucoma agents required, from 2.44 agents pre-operatively to 1.41 post-operatively, p<0.001). 11/39 (28%) patients were able to wean completely off topical anti-glaucoma agents. Adverse events were infrequent and transient. Three eyes had a single implant owing to: shallow implantation (2), intra-operative bleeding (1). Two patients had transient hyphaema settling by 1-week post-operatively.

Conclusions:

This retrospective analysis of surgeon’s first cohort of patients undergoing iStent Inject® implantation with or without cataract surgery demonstrates favourable clinical outcomes and safety profile. Despite our cohort having a high pre-operative drop burden(mean 2.44 agents), they were still able to eliminate the equivalent of one topical anti-glaucoma agent in addition to a mean IOP reduction of 2.8mmHg. Patients with drop intolerances, preservative allergy or concurrent ocular surface disease were able to gain particular benefit from reduced topical drop burden. Finally, we seek to compare clinical outcomes in iStent Inject® implantation with surgeons’ varying sub-specialty experience and learning curves.

Financial Disclosure:

... research is funded, fully or partially, by a company producing, developing or supplying the product or procedure presented