Posters

Treatment with standalone implantation of two trabecular micro-bypass stents combined with topical prostaglandin in OAG on two preoperative medications: 5 year outcomes

Poster Details

First Author: A.Jünemann GERMANY

Co Author(s):                        

Abstract Details

Purpose:

To prospectively assess safety and IOP following standalone implantation of two trabecular bypass stents (iStent®) combined with topical travoprost started 1 day postoperative in eyes with OAG not controlled on 2 ocular hypotensive medications. Topical prostaglandin was chosen for its potential to reduce intraocular pressure (IOP) through a different outflow pathway than the stents.

Setting:

The study was conducted by a subset of the MIGS study group physicians. All surgeries and follow-up visits were completed at the S.V. Malayan Ophthalmological Center in Yerevan, Armenia.

Methods:

This prospective, single-arm, unmasked study enrolled subjects with OAG on 2 preop topical medications. Preoperative mean medicated IOP was 18-30 mmHg and post-washout mean unmedicated IOP was 22-38 mmHg. Subjects were implanted with 2 iStent devices as a standalone procedure, and travoprost was started on postoperative day 1. Annual medication washouts were conducted to assess unmedicated IOP. Efficacy and safety assessments included IOP, medication usage, slit-lamp examination, gonioscopy, fundus/optic nerve evaluation, BCVA, and adverse events (AE).

Results:

Thirty-seven of 39 subjects enrolled completed 5-year follow-ups. Postoperative mean medicated IOP showed consistent reduction to ≤14.0 mmHg at all visits through M60, and was 12.4 mmHg at M60 compared to 22.4 mmHg preop. Postop mean unmedicated IOP was ≤17.7 mmHg at all visits, and was 16.6 mmHg at M60 compared to 25.3 mmHg preoperative. At M60, IOP ≤18 mmHg on travoprost was observed in 88% of subjects. All subjects underwent uncomplicated implantation with 2 iStent devices with no device-related AEs. Reported AEs include progression of pre-existing cataract (5 eyes) and trabeculectomy (one eye) due to glaucoma progression.

Conclusions:

This report builds upon previously published work demonstrating favorable outcomes with iStent implantation for the treatment of OAG. Treatment with 2 iStent devices combined with topical travoprost can safely achieve significant and sustained reduction of IOP to ≤14 mmHg and reduced medication burden through 5 years postoperative. These findings are encouraging and suggest that standalone implantation of multiple iStent devices may be an effective treatment modality for patients with OAG.

Financial Disclosure:

receives consulting fees, retainer, or contract payments from a competing company