Travoprost Intracameral Implant as a Standalone Procedure or Combined with Minimally Invasive Glaucoma Surgery (MIGS)

The primary objective of this study was to report real-world outcomes of the travoprost intracameral implant (iDose TR) as standalone surgery or combined with minimally invasive glaucoma surgery (MIGS). The secondary objective was to compare efficacy across subgroups stratified by surgical category, severity, and race/ethnicity.

This was a retrospective nonrandomized single-center consecutive case series of iDose TR implantations, with or without MIGS. Inclusion criteria were primary open-angle glaucoma, mild-to-severe stage, and minimum 3 months' follow-up. Eyes with visually significant cataract undergoing combined surgery also underwent concomitant phacoemulsification. Efficacy endpoints were mean and proportional analyses of IOP and medication burden (at baseline vs 3 months).

The study included 85 eyes. iDose TR was a standalone procedure in 40 eyes (47.1%) and combined with MIGS in 45 eyes (52.9%): iDose + iStent infinite (n = 22), iDose + iStent infinite + phacoemulsification (n = 16), and iDose + other MIGS ± phacoemulsification (n = 7). IOP and medication burden reduced significantly from 17.2 ± 5.1 and 1.9 ± 1.1 mmHg preoperatively to 14.5 ± 4.3 and 0.9 ± 0.9 mmHg at 3 months in all eyes (p < 0.001). Subgroup analyses revealed significant reductions in IOP and medication burden across all subgroups with no significant between-subgroup differences, except in the surgical category analysis which showed statistically significantly greater medication reduction after combined procedures than standalone procedures. There were no intraoperative complications. Postoperatively, IOP elevation (n = 1) and branch retinal vein occlusion (n = 1) were observed. No secondary glaucoma interventions were required.

iDose TR achieved significant and safe IOP and medication reduction when performed as standalone surgery or combined with trabecular outflow-based MIGS with or without concomitant phacoemulsification. Greater medication-reducing effect was observed following combined iDose TR + MIGS surgery than with standalone iDose TR implantation. Study limitations include the short follow-up, nonrandomized design, and small, unmatched subgroups; further randomized studies with large, matched cohorts will be helpful to validate these findings.