In the JournalsPerspective

iStent reduced IOP and medications through 5 years

A cohort of patients with open-angle glaucoma or ocular hypertension implanted with an iStent after cataract surgery experienced reduced, safe and durable IOP and reduced medications through 5 years after the procedure, according to a study.

“Implantation of a single iStent during small-incision cataract surgery treating elevated IOP by ocular hypertension or POAG is a sustained, safe and effective surgical glaucoma treatment through 5 years postoperative. The majority of our patients love this very special ‘dropless’ comfort knowing that their IOP is controlled by the iStent when we perform glaucoma screenings three to four times a year,” Tobias H. Neuhann, MD, lead study author, told Healio.com/OSN.

The prospective, nonrandomized consecutive case series included 65 eyes of 43 patients with open-angle glaucoma or ocular hypertension. One iStent (Glaukos) was implanted after cataract surgery, and patients were followed for 5 years. Twenty-six eyes completed all 5 years of follow-up.

At 5 years, the mean IOP decreased by 38% to 14.7 mm Hg compared with 23.7 mm Hg preoperatively. In addition, at year 5, 92% of eyes had a mean IOP of 18 mm Hg or lower and 65% had an IOP of 15 mm Hg or lower.

The average medication reduction was 75%, with patients taking 0.5 medications at 5-year follow-up compared with two medications preoperatively. Only 4% of patients remained on three to four medications at 5 years, reduced from 28% preoperatively. Also, 69% of eyes became medication-free compared with 5% preoperatively.

Over the 5-year follow-up, no sight-threatening or device-related adverse events occurred.

Corrected distance visual acuity was preserved at 5 years, with a mean of 20/40 or better in 100% of 24 eyes and 20/25 or better in 79% of 24 eyes. – by Robert Linnehan

Disclosures: Neuhann reports he is paid for presentations by Staar Surgical and Bausch + Lomb. Hornbeak and Giamporcaro report they are employees of Glaukos.

A cohort of patients with open-angle glaucoma or ocular hypertension implanted with an iStent after cataract surgery experienced reduced, safe and durable IOP and reduced medications through 5 years after the procedure, according to a study.

“Implantation of a single iStent during small-incision cataract surgery treating elevated IOP by ocular hypertension or POAG is a sustained, safe and effective surgical glaucoma treatment through 5 years postoperative. The majority of our patients love this very special ‘dropless’ comfort knowing that their IOP is controlled by the iStent when we perform glaucoma screenings three to four times a year,” Tobias H. Neuhann, MD, lead study author, told Healio.com/OSN.

The prospective, nonrandomized consecutive case series included 65 eyes of 43 patients with open-angle glaucoma or ocular hypertension. One iStent (Glaukos) was implanted after cataract surgery, and patients were followed for 5 years. Twenty-six eyes completed all 5 years of follow-up.

At 5 years, the mean IOP decreased by 38% to 14.7 mm Hg compared with 23.7 mm Hg preoperatively. In addition, at year 5, 92% of eyes had a mean IOP of 18 mm Hg or lower and 65% had an IOP of 15 mm Hg or lower.

The average medication reduction was 75%, with patients taking 0.5 medications at 5-year follow-up compared with two medications preoperatively. Only 4% of patients remained on three to four medications at 5 years, reduced from 28% preoperatively. Also, 69% of eyes became medication-free compared with 5% preoperatively.

Over the 5-year follow-up, no sight-threatening or device-related adverse events occurred.

Corrected distance visual acuity was preserved at 5 years, with a mean of 20/40 or better in 100% of 24 eyes and 20/25 or better in 79% of 24 eyes. – by Robert Linnehan

Disclosures: Neuhann reports he is paid for presentations by Staar Surgical and Bausch + Lomb. Hornbeak and Giamporcaro report they are employees of Glaukos.

    Perspective
    John A. Hovanesian

    John A. Hovanesian

    This well-done paper by Tobias Neuhann adds data on 65 more eyes to the already impressive collection of studies showing the long-term benefits of trabecular microbypass stent with the iStent (Glaukos). This cohort includes more cases of advanced glaucoma than most comparable case series because 38% of Neuhann’s eyes had previous glaucoma laser or penetrating surgery and 68% were on two or more preoperative glaucoma medications. Whether advanced or early, glaucoma patients in study after study of trabecular bypass stents achieve significant pressure reduction and elimination of medications. Every cataract surgeon should be familiar with these techniques and devices, and every patient on glaucoma medication who is undergoing cataract surgery should be considered a potential candidate.

    • John A. Hovanesian, MD, FACS
    • OSN Cataract Surgery Section Editor

    Disclosures: Hovanesian reports he is a consultant for Glaukos, Ivantis and several other companies with MIGS procedures or devices.