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Ab interno trabecular bypass surgery with iStent for open-angle glaucoma.

Jimmy T Le1, Amanda K Bicket, Lin Wang

  • 1Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6009, Baltimore, Maryland, USA, 21205.

The Cochrane Database of Systematic Reviews
|March 29, 2019
PubMed
Summary
This summary is machine-generated.

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Minimally invasive glaucoma surgery (MIGS) with iStent may help patients remain drop-free longer. However, the evidence quality is very low, and more research is needed to confirm benefits for glaucoma treatment.

Area of Science:

  • Ophthalmology
  • Glaucoma Research
  • Surgical Innovation

Background:

  • Glaucoma is a leading cause of irreversible blindness globally.
  • Elevated intraocular pressure (IOP) is the primary modifiable risk factor for glaucoma.
  • Minimally invasive glaucoma surgery (MIGS) offers a new treatment approach, with iStent being a notable example.

Purpose of the Study:

  • To evaluate the effectiveness and safety of ab interno trabecular bypass surgery using iStent (or iStent inject).
  • To compare iStent outcomes against conventional medical, laser, or surgical glaucoma treatments.
  • To assess the impact of iStent on maintaining patients 'drop-free' status.

Main Methods:

  • Systematic review of randomized controlled trials (RCTs) comparing iStent/iStent inject with other treatments.

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  • Searched multiple databases (CENTRAL, MEDLINE, Embase, etc.) without date or language restrictions.
  • Included RCTs comparing iStent (alone or with phacoemulsification) to control groups (medical, laser, surgery, or phacoemulsification alone).

    • Main Results:

    • Seven RCTs (765 eyes) evaluated iStent for open-angle glaucoma; most trials had high risk of bias and were industry-funded.
    • iStent combined with phacoemulsification showed a higher likelihood of being drop-free (RR 1.38) and a small reduction in IOP-lowering drops.
    • Two RCTs comparing iStent to medical therapy indicated over 90% of participants were drop-free, versus none in the medical group, but heterogeneity was noted.

    Conclusions:

    • Very low-quality evidence suggests iStent may increase the proportion of drop-free patients and improve IOP control.
    • Results from 13 ongoing studies may provide further clarity on iStent's benefits.
    • Future MIGS research should incorporate quality of life and vision-dependent activity measures.