Prospective Evaluation of Two iStent® Trabecular Stents, One iStent Supra® Suprachoroidal Stent, and Postoperative Prostaglandin in Refractory Glaucoma: 4-year Outcomes

Myers, Jonathan S.; Masood, Imran; Hornbeak, Dana M.; Belda, José I; Auffarth, Gerd U.; Jünemann, Anselm; Giamporcaro, Jane Ellen; Martinez-de-la-Casa, José M.; Ahmed, Iqbal Ike K.; Voskanyan, Lilit; Katz, L. Jay

doi:10.1007/s12325-018-0666-4

Cited by 67 publications

(50 citation statements)

References 45 publications

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“…This stent allows circumvention of the damaged trabecular meshwork by creating a direct route from the anterior chamber to Schlemm's canal. Considerable evidence has shown the stents' ability to provide meaningful postoperative reductions in IOP and medication burden for up to 5 years with or without concomitant cataract surgery, and in various subtypes and severities of glaucoma [11][12][13][14][15][16][17]. Moreover, these benefits have occurred with favorable safety and minimal disruption to ocular structures.…”

Section: Introductionmentioning

confidence: 99%

One-Year Outcomes of Second-Generation Trabecular Micro-Bypass Stents (iStent Inject) Implantation with Cataract Surgery in Different Glaucoma Subtypes and Severities

2019

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Purpose: To assess the 1-year efficacy and safety of the implantation of two second-generation trabecular micro-bypass stents (iStent Inject Ò) with concomitant cataract surgery in various subtypes and severities of glaucoma. Methods: This single-surgeon, consecutive case series from a Canadian academic ophthalmology center included subjects with cataract, glaucoma, and the need to reduce intraocular pressure (IOP) and/or medications. The 12-month outcomes included mean IOP and medication burden as well as the proportions of eyes with IOP B 18, B 15, and B 12 mmHg compared to baseline. Other measures included corrected distance visual acuity (CDVA), cup-todisc ratio (CDR), visual field mean deviation (VF MD), retinal nerve fiber layer (RNFL) thickness, ganglion cell inner plexiform layer (GCIPL) thickness, and adverse events. Results: In 118 eyes, mean IOP reduced from 17.00 ± 3.82 mmHg preoperatively to 13.97 ± 2.65 mmHg at the 12-month follow-up mark (17.8% reduction, p \ 0.001), and mean medication burden decreased from 2.31 ± 1.33 preoperatively to 1.03 ± 1.10 medications (56% reduction, p \ 0.001). After 12 months, 93% of eyes achieved IOP B 18 mmHg (versus 69% preoperatively), 70% of eyes achieved IOP B 15 mmHg (versus 42% preoperatively), and 29% of eyes achieved IOP B 12 mmHg (versus 7% preoperatively). For all eyes, topical medications were either maintained or decreased from baseline, with C 1 medication eliminated from the preoperative regimen for 83% of eyes and C 2 medications eliminated for 36% of eyes. Visual acuity improved significantly, consistent with expectations for cataract surgery, while CDR, VF MD, and RNFL and GCIPL thicknesses remained stable. Safety was favorable, with no intraoperative complications and few transient adverse events postoperatively. Conclusion: iStent Inject implantation with cataract surgery safely reduced IOP and medication burden in a real-world clinical population with mild to severe glaucoma, and Enhanced Digital Features To view enhanced digital features for this article go to https://doi.org/10.6084/ m9.figshare.9762590.

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Section: Introductionmentioning

confidence: 99%

One-Year Outcomes of Second-Generation Trabecular Micro-Bypass Stents (iStent Inject) Implantation with Cataract Surgery in Different Glaucoma Subtypes and Severities

2019

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“…[32][33][34][35][36] iStent, Trabectome, and Xen had the highest number of prospective studies. There were 29 prospective studies of the iStent (25 iStent, 3 iStent inject, 62-64 1 iStent +Supra), 65 with quality scores ranging from −1 to 5. There were 16 prospective studies of the Trabectome, [66][67][68][69][70][71][72][73][74][75][76][77][78][79][80][81] but many described the outcomes of patients who had Trabectome using data from the Trabectome Database; thus, while the data were collected prospectively, the research questions were asked retrospectively, and many of these studies had lower quality scores based on lack of control group.…”

Section: Resultsmentioning

confidence: 99%

<p>Prospective Studies of Minimally Invasive Glaucoma Surgeries: Systematic Review and Quality Assessment</p>

Rosdahl¹,

Gupta²

2020

OPTH

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Glaucoma is a common blinding disease; while there is no cure, effective treatments include medications, laser, and incisional surgery. There is significant interest from patients and doctors to develop safer surgical options throughout the spectrum of disease, to minimize treatment burden in mild glaucoma patients and to minimize risk of complications in patients needing more aggressive treatment. Surgical procedures called Minimally or Micro-Invasive Glaucoma Surgery (MIGS) are growing in popularity. Eightyseven prospective studies on MIGS were identified and assessed for quality. Most (74%) did not have a control group. Twelve of the highest quality were reviewed. MIGS procedures appeared to have fewer complications, and lowered intraocular pressure, and reduced medication use. Studies were limited by small sample size, narrow spectrum of glaucomatous disease, and/or conflicts of interest. There is a need for high quality, independently funded and performed, comparative studies on the MIGS to help make treatment decisions.

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“…Although of interest in clinical practice, scant studies have accessed the role of combining MIGS [54], and only limited evidence is available to demonstrate whether combining MIGS is additive with respect to IOP control [55]. In our experience, ECP can be combined with outflow-targeted procedures such as KDB goniotomy to optimize IOP reduction, and this can be done cautiously but successfully in eyes with severe disease for whom the alternative might be incisional surgery.…”

Section: Combination Migsmentioning

confidence: 96%

An Update on Microinvasive Glaucoma Surgery Concurrent With Cataract Extraction

Tassel

Chen

2019

Curr Ophthalmol Rep

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Purpose of Review In this article, we review the current options for microinvasive glaucoma surgery (MIGS) combined with cataract extraction in the USA and the efficacy of the various approaches. Recent Findings MIGS is a rapidly growing area of research and clinical interest. Available surgeries aim to reduce intraocular pressure by improving aqueous outflow through the trabecular or subconjunctival pathways or by reducing aqueous production. Summary Multiple approaches to MIGS are utilized in clinical practice. On average, these surgeries are safe and modestly effective in reducing intraocular pressure. Future research will demonstrate which surgical approaches are most efficacious, whether and how to combine MIGS, and the role of MIGS in improving patient quality of life.

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Prospective Evaluation of Two iStent® Trabecular Stents, One iStent Supra® Suprachoroidal Stent, and Postoperative Prostaglandin in Refractory Glaucoma: 4-year Outcomes

Cited by 67 publications

References 45 publications

One-Year Outcomes of Second-Generation Trabecular Micro-Bypass Stents (iStent Inject) Implantation with Cataract Surgery in Different Glaucoma Subtypes and Severities

One-Year Outcomes of Second-Generation Trabecular Micro-Bypass Stents (iStent Inject) Implantation with Cataract Surgery in Different Glaucoma Subtypes and Severities

<p>Prospective Studies of Minimally Invasive Glaucoma Surgeries: Systematic Review and Quality Assessment</p>

An Update on Microinvasive Glaucoma Surgery Concurrent With Cataract Extraction

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