iStent inject Trabecular Micro-Bypass with or Without Cataract Surgery Yields Sustained 5-Year Glaucoma Control.

Area of Science:

• Ophthalmology
• Glaucoma treatment
• Minimally invasive glaucoma surgery

Background:

• Open-angle glaucoma (OAG) is a progressive optic neuropathy often requiring lifelong medical and surgical management.
• Trabecular micro-bypass surgery offers a less invasive approach to reduce intraocular pressure (IOP).
• The iStent inject is a specific trabecular micro-bypass device designed for glaucoma management.

Purpose of the Study:

• To evaluate the 5-year effectiveness and safety of the iStent inject trabecular micro-bypass.
• To compare outcomes when iStent inject is used with cataract surgery (Combined) versus alone (Standalone).
• To assess the durability of IOP and medication reduction, and disease stability over a 5-year period.

Main Methods:

• A prospective longitudinal case series involving consecutive iStent inject implantations by a single surgeon.
• Assessment of intraocular pressure (IOP), medication usage, safety, and disease stability indicators over 5 years.
• Subgroup analyses were performed for Combined (with cataract surgery) and Standalone (without cataract surgery) procedures.

Main Results:

• Mean IOP reduced from 23.5 mmHg to 14.1 mmHg (40% decrease) and medications from 2.68 to 0.77 (71% decrease) at 5 years (p < 0.001).
• 46% of patients were medication-free at 5 years.
• Both Combined and Standalone groups showed significant IOP and medication reductions with favorable safety profiles (0 complications, 0 filtration surgeries).
• Long-term disease parameters (visual fields, RNFL, C:D ratio) remained stable.

Conclusions:

• iStent inject provides significant and durable 5-year IOP and medication reduction in OAG patients.
• The procedure demonstrates a favorable safety profile with stable disease parameters.
• Outcomes were comparable between combined cataract surgery and standalone iStent inject procedures.