My observations after almost 300 trabecular micro-bypass glaucoma surgeries with iStent inject over a period of five years

Session Details

Session Title: Microinvasive Glaucoma Surgery

Session Date/Time: Sunday 15/09/2019 | 14:00-16:00

Paper Time: 15:36

Venue: Free Paper Forum: Podium 4

First Author: : T.Neuhann GERMANY

Co Author(s): :                                 

Abstract Details

Purpose:

To investigate the safety and performance of iStent inject trabecular micro-bypass stenting in various glaucoma types. Additionally, the surgeon also noted surgical techniques that would improve the surgical procedure.

Setting:

Private eye clinic, Munich, Germany

Methods:

Retrospective evaluation of patient data after implantation of the iStent inject (Glaukos, San Clemente, USA) as a stand-alone surgery or in combination with cataract surgery. Key clinical measures were IOP reduction and medication requirement after surgery. Surgical technique was also evaluated. Glaucoma diagnoses were: primary open-angle glaucoma (52.49%), PEX (25.41%), normal-tension glaucoma (10.50%), pigmentary glaucoma (0.55%), and ocular hypertension (11.05%). Patient follow-up is ongoing with an aim to report on longer-term outcomes.

Results:

Two-hundred seventy (270) surgeries have been successfully performed with follow-up out to 2 years in a subset of patients. Mean preoperative IOP was 19.7±5.5 mmHg on 2.0±1.1 medications (n=270). IOP decreased to 15.0±2.2 mmHg at year-1 (n=192) and 15.1±1.0 mmHg at year-2 (n=104). Medication was reduced to 0.3±0.7 and 0.4±0.8 year-1 and year-2, respectively. For patients who have reached 2 years postoperative, 98% achieved IOP ≤18 mmHg, 91% had a reduction in medications from baseline and 72% were medication-free. A high safety profile was demonstrated with no significant intraoperative or postoperative complications.

Conclusions:

The evaluation of currently available patient data of one surgeon’s experience demonstrate that trabecular micro-bypass stenting with the iStent inject, as a stand-alone surgery or in combination with cataract surgery, safely reduces IOP and medication burden. The outcomes demonstrate safety and performance out to 2 years. With regards to surgical approach in combined surgeries, the surgeon shifted towards implanting the iStent prior to cataract surgery (vs after) due to improved intraoperative visualisation through the cornea. Another surgical technique noted was the use of the viscoelastic agent hydroxypropyl methylcellulose in PEX cases to maintain and normalize potential postoperative IOP elevation.

Financial Disclosure:

None