iStent versus iStent inject implantation combined with phacoemulsification in open angle glaucoma

Abstract

Purpose: To compare the outcomes of iStent vs. iStent inject implantation combined with phacoemulsification. Methods: This single center retrospective comparative case series included subjects with open angle glaucoma who underwent iStent or iStent inject implantation combined with phacoemulsification with ≥1 year follow-up. The main outcome measures were in-group and between-group changes in intraocular pressure (IOP) and medication number, proportion of eyes that achieved IOP ≤15 mmHg, and surgical success defined as 20% IOP reduction from baseline at 6/12 months. Univariate/multivariate regression analyses were done to identify predictors of surgical failure. Results: One hundred ninety-seven eyes of 148 patients were included (122 iStent, 75 iStent inject). Both groups achieved significant IOP and medication reduction at months 6/12 (P < 0.05). At month 6, IOP was significantly lower in iStent inject vs. iStent eyes (P = 0.003), but the difference was insignificant by month 12 (P = 0.172). Medication number was comparable in both groups at months 6/12 (P > 0.05). More iStent inject eyes achieved IOP ≤15 mmHg at month 6 (P = 0.003) and 12 (P = 0.047). Surgical success was comparable in both groups at months 6/12 (P > 0.05). Kaplan–Meier survival analysis showed similar cumulative rate of surgical failure at year-1 in both groups (P = 0.644). The multivariate model identified older age (P = 0.017) and lower baseline IOP (P = 0.002) as the strongest predictors of surgical failure. Conclusion: Compared to iStent, iStent inject achieved lower IOP at month 6 and higher proportion of eyes achieved IOP ≤15 mmHg at month 6/12. However, surgical success was similar in both groups. Predictors of surgical failure were older age and lower baseline IOP rather than the stent type.

Minimally Invasive Glaucoma Surgery

“…35,36 Shalaby et al found that compared with eyes undergoing phaco/iStent with the first-generation device, phaco/iStent inject eyes exhibited greater IOP reduction (14.9 ± 3.6 vs. 15.1 ± 3.5 mm Hg, P = 0.003) and a higher proportion achieving postoperative IOP < 15 mm Hg (70.7% vs. 49.2%, P = 0.003). 37 Similar results were observed by Guedes et al in a longitudinal retrospective study including 73 eyes (38 eyes phaco/iStent first generation, 35 phaco/iStent inject). After 6 months, phaco/iStent inject eyes demonstrated a significantly greater IOP reduction (26.6% vs. 15.8%, P = 0.005), with a higher percentage of iStent inject eyes achieving IOP < 18 mm Hg (100% vs. 86.8%).…”

“…The iStent inject has shown greater efficacy compared with the first-generation iStent 35,36 . Shalaby et al found that compared with eyes undergoing phaco/iStent with the first-generation device, phaco/iStent inject eyes exhibited greater IOP reduction (14.9 ± 3.6 vs. 15.1 ± 3.5 mm Hg, P = 0.003) and a higher proportion achieving postoperative IOP < 15 mm Hg (70.7% vs. 49.2%, P = 0.003) 37 . Similar results were observed by Guedes et al in a longitudinal retrospective study including 73 eyes (38 eyes phaco/iStent first generation, 35 phaco/iStent inject).…”

Spotlight on Schlemm’s Canal MicroStent Injection in Patients with Glaucoma

“…In a study of 197 eyes with mild to severe open-angle glaucoma, Shalaby et al observed that eyes implanted with the iStent inject achieved lower IOPs at month 6 (−14% vs −8%), with comparable surgical success (>20% IOP reduction from baseline) seen in both groups at 6 and 12 months after surgery. 24 Both groups experienced significant medication reductions (−35% vs −18%) and improvement in visual field mean deviation at 12 months. 24 Guedes et al compared outcomes in 58 eyes with primarily (96.6%) mild-to-moderate open-angle glaucoma and observed greater efficacy in the iStent inject group, with a significantly higher percentage of iStent inject eyes achieving an IOP <18 mmHg (100% vs 80%) and <15 mmHg (73.9% vs 34.3%) at 12 months.…”

“… 24 Both groups experienced significant medication reductions (−35% vs −18%) and improvement in visual field mean deviation at 12 months. 24 Guedes et al compared outcomes in 58 eyes with primarily (96.6%) mild-to-moderate open-angle glaucoma and observed greater efficacy in the iStent inject group, with a significantly higher percentage of iStent inject eyes achieving an IOP <18 mmHg (100% vs 80%) and <15 mmHg (73.9% vs 34.3%) at 12 months. 25 Mean medication numbers were also significantly lower in the iStent inject group (0.1 vs 0.5 medications).…”

„Minimally invasive glaucoma surgery“ – Kammerwinkelbasierte Verfahren im Vergleich

“…Diese Ergebnisse wurden von Manning auch in einem Vergleich 12 Monate nach der Implantation bestätigt [14]. Shalaby et al stellten nach 12 Monaten keinen signifikanten Unterschied in der IOD-Senkung fest, aber die benötigten topischen Antiglaukomatosa konnten nach iStents inject-Implantation stärker reduziert werden als nach Implantation von iStents der ersten Generation [15].…”