PARIS — Five years of follow-up in a large series of patients implanted with the iStent inject, mostly combined with cataract surgery, showed sustained IOP reduction, with 75% of eyes remaining medication-free.
At the European Society of Cataract and Refractive Surgeons meeting, Tobias Neuhann, MD, presented results of a retrospective analysis of 270 patients he personally implanted with the iStent inject (Glaukos) over 5 years. In 91% of the cases, the procedure was combined with cataract surgery.
“Results were excellent. Mean IOP at 5 years was 16 mm Hg or less in 75% of the patients, and 70% were medication-free. The cup-disc ratio became progressively smaller,” he said.
Over time, Neuhann changed his technique and started implanting the iStent inject before and not after cataract surgery and IOL implantation. In his opinion, there is no anatomical or surgical need to implant the stent after cataract surgery, while there are several good reasons to do it before. First, the cornea is clearer at the beginning of surgery, and the anterior chamber more stable when filled with viscoelastic before cataract removal, he said.
“Also, since the bleeding of the Schlemm’s canal will stop more often during cataract surgery than at the end of surgery, we’ll have fewer iStent-induced hyphema in the first postoperative day. Complete removal of viscoelastic is also easier if the iStent is placed prior to cataract surgery and the IOL is implanted under [balanced salt solution] irrigation,” he said.
Surgeons should anticipate the difficulty of implanting the iStent inject if complications occur during cataract surgery, according to Neuhann.
“Although the company recommends implanting the stent after cataract surgery, I recommend starting the combined procedure with the iStent implantation for best outcomes for both yourself and the patient,” he said. – by Michela Cimberle
Neuhann T. My observations after almost 300 trabecular micro-bypass glaucoma surgeries with iStent inject over a period of five years. Presented at: European Society of Cataract and Refractive Surgeons meeting; Sept. 13-18, 2019; Paris.
Disclosure: Neuhann reports no relevant financial disclosures.