Two-Year Comparative Outcomes of First- and Second-Generation Trabecular Micro-Bypass Stents with Cataract Surgery

Area of Science:

• Ophthalmology
• Glaucoma Research
• Surgical Innovation

Background:

• Open-angle glaucoma (OAG) management often involves medication and surgical interventions.
• Trabecular micro-bypass stents offer a minimally invasive approach to reduce intraocular pressure (IOP).
• Comparative effectiveness of first-generation (iStent) and second-generation (iStent inject) stents requires real-world evaluation.

Purpose of the Study:

• To compare the real-world effectiveness and safety of iStent and iStent inject trabecular micro-bypass stents.
• To evaluate IOP and glaucoma medication reduction following stent implantation combined with cataract surgery.
• To assess long-term outcomes up to 24 months postoperatively.

Main Methods:

• Retrospective comparative study of patients with OAG undergoing cataract surgery with either iStent or iStent inject.
• 24-month postoperative follow-up to assess intraocular pressure (IOP) reduction.
• Quantification of mean glaucoma medication reduction and analysis of IOP control with and without medications.
• Evaluation of safety through visual acuity, adverse events, and secondary surgery rates.

Main Results:

• iStent inject achieved a greater mean IOP reduction (26.0%) compared to iStent (9.8%) at 24 months (p=0.019).
• Both stent groups showed significant medication burden reduction (over 70%), from a mean of 1.74 to 0.51 (iStent) and 2.19 to 0.65 (iStent inject).
• Higher baseline IOP correlated with greater postoperative IOP reduction within both groups (p<0.001).

Conclusions:

• Both iStent and iStent inject, when combined with phacoemulsification, provide significant and sustained IOP and medication reduction for OAG patients.
• The iStent inject demonstrated superior IOP lowering efficacy compared to the iStent over a two-year period.
• The safety profile for both trabecular micro-bypass stents was excellent, with no major adverse events reported.