Generation 1 iStent occlusion in angle closure glaucoma as a reason for postoperative intraocular pressure spike...

Area of Science:

• Ophthalmology
• Glaucoma Management
• Surgical Interventions

Background:

• Primary angle closure glaucoma presents unique challenges for intraocular pressure (IOP) management.
• Microinvasive glaucoma surgery (MIGS) with devices like the iStent is increasingly used, but its behavior in angle closure needs further study.
• First-generation iStent implantation combined with phacoemulsification is a common surgical approach.

Purpose of the Study:

• To report the clinical behavior of a first-generation iStent in a patient with primary angle closure glaucoma.
• To investigate a complication of iStent implantation: stent lumen obstruction.
• To evaluate the efficacy of a non-invasive intervention for managing iStent occlusion.

Main Methods:

• Case report of a primary angle closure glaucoma patient undergoing phacoemulsification with iStent implantation.
• Postoperative monitoring including intraocular pressure (IOP) measurement and gonioscopy.
• Intervention with pilocarpine 2% eye drops for managing stent occlusion.

Main Results:

• A sudden IOP spike occurred 5 days postoperatively, attributed to peripheral iris incarceration obstructing the iStent lumen.
• Topical pilocarpine 2% successfully relieved the iris incarceration and normalized IOP.
• The patient achieved significant IOP reduction (48%) and remained medication-free for 6 months.

Conclusions:

• Stent occlusion is a potential complication of iStent implantation in angle closure glaucoma, requiring careful monitoring.
• Non-invasive management with pilocarpine can be effective in resolving iStent occlusion caused by iris incarceration.
• Prophylactic pilocarpine use may reduce the risk of early postoperative stent occlusion in these patients.