Advances in minimally invasive glaucoma surgery
One surgeon’s experiences with the iStent trabecular micro bypass; an implant that forms a patent opening through the trabecular meshwork into Schlemm’s canal, restoring physiological aqueous outflow and providing a significant and sustained decrease in IOP.
Take-home message: One surgeon’s experiences with the iStent trabecular micro bypass; an implant that forms a patent opening through the trabecular meshwork into Schlemm’s canal, restoring physiological aqueous outflow and providing a significant and sustained decrease in IOP.
By Dr Fritz Hengerer
The glaucoma surgical therapy field has grown enormously in the last few years, providing ophthalmologists and their patients myriad options that are less invasive and safer than the traditional trabeculectomy. While many pharmacotherapies address high intraocular pressure (IOP) by reducing aqueous production, most surgical therapies are aimed at improving aqueous outflow. The conventional pathway for aqueous humor includes the trabecular meshwork, Schlemm’s canal and collector channels, with the trabecular meshwork contributing the majority of resistance to aqueous outflow in both normal and glaucomatous eyes.1-3
iStent trabecular micro bypass
The iStent trabecular micro bypass (Glaukos Corp., California, USA) forms a patent opening through the trabecular meshwork into Schlemm’s canal, restoring physiological aqueous outflow and providing a significant and sustained decrease in IOP. iStent inject is the second-generation trabecular bypass system by Glaukos that has been available only in Germany for the past year. While the iStent was already the smallest device known to be implanted in humans at 1 mm long by 0.33 mm in height, the new iStent inject is one-third of the size at 0.4 mm tall with a diameter of 0.3 mm (Figure 1).
Multiple clinical trials have established the efficacy of a single stent placement in combination with phacoemulsification to provide a significant, long-term decrease in IOP and the number of medications required.4-8 These have been followed by a growing body of literature demonstrating efficacy of iStent as a stand-alone procedure, as well as the placement of multiple stents to titrate therapy.9,10 A recent pan-European, multicentre, prospective, controlled study of 192 open angle glaucoma (OAG) patients uncontrolled on one medication compared placement of 2 iStent injects to pharmacotherapy with 2 medications.11 Patients receiving the stent (n = 94) had a mean IOP drop of 8.1 mmHg, resulting in a reduction > 20% from baseline in 95% of patients. In comparison, patients in the medical therapy cohort saw a mean IOP drop of 7.3 mmHg, with 92% achieving an IOP reduction > 20%.
iStent inject delivers compelling clinical benefits with no medication burden or doubts about compliance, along with a highly favorable safety profile.
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