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Minimally invasive glaucoma surgery: Comparison of iStent with iStent inject in primary open angle glaucoma
Joobin Hooshmand1, Philip Rothschild1,2, Penny Allen1,2
1Tasmanian Eye Institute, Launceston, Tasmania, Australia.
Clinical & Experimental Ophthalmology
|April 30, 2019
Summary
This study compared iStent and iStent inject for primary open angle glaucoma. Both stents effectively lowered intraocular pressure (IOP) and medication needs when combined with cataract surgery.
Area of Science:
- Ophthalmology
- Glaucoma Surgery
- Minimally Invasive Procedures
Background:
- Primary open-angle glaucoma (POAG) management often involves reducing intraocular pressure (IOP).
- Trabecular micro-bypass stents offer a minimally invasive surgical option.
- Comparing first-generation (iStent) and second-generation (iStent inject) devices is crucial for clinical decision-making.
Purpose of the Study:
- To evaluate and compare the efficacy of single iStent versus double iStent inject in patients with POAG.
- To assess the impact on intraocular pressure (IOP), medication reliance, and complications.
- To determine the long-term effectiveness and safety profile of both stent generations.
Main Methods:
- A prospective comparative case series involving patients with POAG undergoing combined cataract surgery and trabecular micro-bypass stent insertion.
- Data collected included demographics, preoperative and postoperative IOP, visual acuity, medication use, and complications.
- Outcome measures were defined as achieving specific IOP levels (≤18 mmHg) with zero or reduced medications, or a 20% IOP reduction.
Main Results:
- The study included 145 eyes (iStent) and 100 eyes (iStent inject).
- At 12 months, success rates were comparable: 56.0% (iStent) vs. 51.3% (iStent inject) for primary success, and 63.1% vs. 57.7% for secondary success.
- Mean postoperative IOP was similar (16.6 mmHg vs. 16.9 mmHg); however, iStent inject showed a higher failure incidence beyond 5 months.
Conclusions:
- Both iStent and iStent inject are effective in reducing IOP and medication burden when combined with cataract surgery in POAG patients.
- No statistically significant differences were observed in primary outcome measures between the two stent types.
- The iStent inject demonstrated a trend towards requiring earlier recommencement of medications for sustained IOP control.
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