Evaluation of iStent Inject® Trabecular Microbypass Stent Implantation With Phacoemulsification in Cases of Mild to...

The iStent inject® (second generation) is an example of a minimally invasive glaucoma surgery (MIGS) device being increasingly used in the management of glaucoma. It is a recent advancement in the field of glaucoma treatment and can be performed simultaneously with cataract surgery.

The primary objective is to evaluate the change in intraocular pressure (IOP), with secondary objectives to assess the medication burden and safety profile of the implantation of the two second-generation iStent inject trabecular microbypass stents with concomitant phacoemulsification.

A service evaluation of the procedure was conducted over multiple hospital sites across the East Kent Hospitals University NHS Foundation Trust. A data set of 102 eyes was generated, which underwent combined phacoemulsification and iStent inject implantation under three iStent surgeons. This data set included information on preoperative and postoperative IOP, complications, and the number of glaucoma medications established.

There was a reduction of 43.5% in mean IOP in the 102 eyes from a preoperative IOP mean of 22.0 ± 8.54 mmHg (mean ± standard deviation) to a postoperative IOP of 12.4 ± 4.21 mmHg (p < 0.001). There was a reduction in the mean number of medications in the overall cohort by 11.7% from 2.74 ± 1.15 preoperatively to 2.42 ± 1.01 postoperatively (p < 0.001). Ninety (88.2%) eyes had a reduction of ≥20% in IOP. No intraoperative complications were recorded, and two (2%) eyes developed cystoid macular oedema (CMO) postoperatively. There were no other adverse effects or complications reported.

Significant reductions in IOP and medication burden were identified in this cohort of 102 eyes. It has been observed to be a safe surgery with a high safety profile. The utilization of this concomitant surgery could help reduce the number of follow-ups required for patients with glaucoma compared to exclusively medical control or advanced glaucoma surgery and lead to significantly less theater time.