Recurrent hyphema following iStent surgery managed by surgical removal

Khouri, Albert S; Megalla, Marez

doi:10.1016/j.jcjo.2016.06.017

Cited by 10 publications

(5 citation statements)

References 6 publications

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“…Another concern is a late onset of intraocular bleeding into the anterior chamber, as has been described in patients 2-31 months after trabectome surgery [8]. Khouri et al, as well as Sandhu et al, describe a case of late onset and recurring bleeding after a single iStent insertion (not iStent inject) [11,12]. While Khouri et al detected a malposition of the iStent leading to bleeding events, Sandhu et al concluded that the bleeding resulted from reflux from Schlemm's canal into the anterior chamber.…”

Section: Discussionmentioning

confidence: 99%

Influence of oral anticoagulation on success rates and risk of bleeding events after iStent inject implantation combined with phacoemulsification

Widder

Lappas

Rennings

et al. 2020

Graefes Arch Clin Exp Ophthalmol

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Purpose We conducted a retrospective study to evaluate the intraocular pressure (IOP) lowering effect, the success rates, and the risk of bleeding events of patients receiving an iStent inject combined with phacoemulsification under anticoagulation therapy compared with a matched control group. Methods In this retrospective study, sixty-four eyes underwent an iStent inject implantation combined with phacoemulsification at two centers. Thirty-two eyes received surgery while under anticoagulation therapy, and another thirty-two eyes served as a control group matched for visual acuity, IOP, and medication score. Success was defined as criteria A and B (IOP < 18/21 mmHg, > 20% IOP reduction, no resurgery) and criteria C (IOP ≤ 15 mmHg, IOP reduction ≥ 40%, no resurgery). The clinical goal of the study was to determine the difference between the study and control groups with respect to IOP, medication score, and the frequency of intraoperative and postoperative bleeding events. Results After a mean follow-up time of 1 year, the IOP lowered 28% from 20.1 ± 4.8 to 14.5 ± 3.7 mmHg in the group of 64 eyes. The medication score lowered 38% from 2.1 ± 1.1 to 1.3 ± 1.2. The two groups with and without anticoagulant agents did not significantly differ in postoperative IOP, medication score, success rates, or number of bleeding events. Conclusion We conclude that in cataract surgery combined with the iStent inject a discontinuation of anticoagulant agents might not be necessary. It might be a good option in glaucoma surgery when anticoagulation treatment should not be interrupted and the target pressure is not very low.

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Section: Discussionmentioning

confidence: 99%

Influence of oral anticoagulation on success rates and risk of bleeding events after iStent inject implantation combined with phacoemulsification

Widder

Lappas

Rennings

et al. 2020

Graefes Arch Clin Exp Ophthalmol

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“…The 1‐mm long, L‐shaped first‐generation device, iStent, is slightly more difficult to implant owing to its size and shape. Higher incidence of intraoperative hyphaema is also reported with occasional recurrence and lumen blockage requiring implant removal . The second‐generation device, iStent inject , is a much smaller implant at 0.4‐mm long and was specifically designed for ease of insertion.…”

Section: Discussionmentioning

confidence: 99%

“…Higher incidence of intraoperative hyphaema is also reported with occasional recurrence and lumen blockage requiring implant removal. 9 The second-generation device, iStent inject, is a much smaller implant at 0.4-mm long and was specifically designed for ease of insertion. The iStent inject's preloaded injector is also equipped with two implants usually utilized at the same time, thereby reducing the impact of single implant blockage.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive glaucoma surgery: Comparison of iStent with iStent inject in primary open angle glaucoma

Hooshmand¹,

Rothschild

Allen

et al. 2019

Clinical Exper Ophthalmology

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Importance Minimally invasive glaucoma surgery has gained significant traction in recent years. This study evaluates the first‐ and second‐generation trabecular micro‐bypass stents “iStent” and “iStent inject”. Background To evaluate and compare the effect of a single iStent and double iStent inject in primary open angle glaucoma. Design Prospective comparative case series. Participants Primary open angle glaucoma patients undergoing trabecular micro‐bypass stent insertion combined with cataract surgery. Methods Baseline demographic information, preoperative, intraoperative and postoperative outcomes including intraocular pressure (IOP), visual acuity, reliance on glaucoma medication and complications were collected and analysed. Main Outcome Measures Primary, secondary and tertiary outcome measures were consecutively defined as an IOP of ≤18 mmHg with zero medications, an IOP of ≤18 mmHg with reduced medications or a 20% reduction in IOP with or without medication. Results The study comprised 145 eyes in the iStent and 100 eyes in the iStent inject group. At 12 months, 56.0% of the iStent and 51.3% of the iStent inject eyes had achieved primary success and 63.1% and 57.7% secondary success. The mean postoperative IOP was 16.6 mmHg in iStent and 16.9 mmHg in iStent inject. Survival analysis demonstrated a greater incidence of failure in the iStent inject beyond 5 months. Conclusions and Relevance Both trabecular micro‐bypass stents in this study were effective in reducing IOP and the burden of medication when combined with cataract surgery. There was no statistically significant difference between the two groups across our outcome measures although the iStent inject required earlier recommencement of medications for optimal IOP control.

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“…Sandhu et al [ 7 ] reported the case of a 77-year-old woman with bilateral exfoliative glaucoma who developed recurrent microhyphema and rises in IOP upon waking from sleep 13 months and 19 months postoperatively. Khouri et al [ 8 ] reported a case of recurrent hyphema and refractory increased IOP in an iStent patient secondary to stent malposition; surgical removal of the stent resolved the recurrent hyphema and elevated IOP.…”

Section: Discussionmentioning

confidence: 99%

“…The iStent is often implanted at the time of cataract surgery. To date, there have been 2 reports of recurrent hyphema occuring after iStent implantation; the first was presumed to be due to blood reflux through Schlemms canal that resolved without intervention [ 7 ], and the other was presumed to be due to iStent malposition that was resolved by surgical removal [ 8 ]. We present a unique case of a patient who experienced episodic, recurrent hyphema and uveitis with high IOP after iStent implantation despite an appropriately placed stent, verified by gonioscopy, anterior segment OCT and ultrasound biomicroscopy (UBM).…”

Section: Introductionmentioning

confidence: 99%

Uveitis-Glaucoma-Hyphema Syndrome Following iStent Implantation

Siedlecki

Kinariwala²,

Sieminski³

2022

Case Rep Ophthalmol

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Minimally invasive glaucoma surgery (MIGS) is a subset of glaucoma surgery that is known for its low rate of complications both intraoperatively and postoperatively compared to traditional filtering surgery. We present a case of a patient who, after receiving uncomplicated cataract extraction with posterior chamber intraocular lens implantation and concurrent iStent trabecular bypass stent implantation, experienced recurrent episodes of spontaneous microhyphema and inflammation in the late postoperative period. The patient, who had a history of mild asymmetric exfoliative glaucoma but no identifiable sources of trauma, underwent extensive examination to investigate causes of his episodic anterior segment bleeding and mild inflammation with concurrent elevated intraocular pressure. Given the circumstances of the patient’s recurrent symptoms and a negative workup for conventional causes of recurrent hyphema, it was suspected that the patient’s iStent was interacting with the patient’s peripheral iris, causing microtrauma and hyphema. We hypothesized that this contact was potentially exacerbated by pre-existing exfoliation syndrome, which caused zonular weakness and subsequent anterior movement of the lens-iris diaphragm. After the patient’s third recurrence of microhyphema and inflammation, the patient underwent removal of iStent and concurrent OMNI canaloplasty for glaucoma. Six months post-iStent explantation, the patient has had complete resolution of symptoms without recurrence of hyphema. In this case report, we outline the course of this patient’s symptoms and diagnosis, discuss the potential of MIGS devices such as iStent to cause recurrent hyphema, and explore treatment options following removal.

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Recurrent hyphema following iStent surgery managed by surgical removal

Cited by 10 publications

References 6 publications

Influence of oral anticoagulation on success rates and risk of bleeding events after iStent inject implantation combined with phacoemulsification

Influence of oral anticoagulation on success rates and risk of bleeding events after iStent inject implantation combined with phacoemulsification

Minimally invasive glaucoma surgery: Comparison of iStent with iStent inject in primary open angle glaucoma

Uveitis-Glaucoma-Hyphema Syndrome Following iStent Implantation

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