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Treatment with 2 second-generation trabecular micro-bypass stents and postoperative topical prostaglandin in eyes with open-angle glaucoma taking 2 preoperative medications: outcomes through 30 months

Poster Details

First Author: J.Martinez de la Casa SPAIN

Co Author(s):                        

Abstract Details

Purpose:

To evaluate efficacy and safety parameters through 5 years following treatment with 2 second-generation trabecular micro-bypass stents (iStent inject�Â�®, Glaukos) and a postoperative topical prostaglandin in subjects with open-angle glaucoma (OAG) on 2 preoperative medications (one a prostaglandin). The iStent inject devices are inserted in Schlemm�â�€�™s canal via ab interno implantation and can reestablish physiologic outflow and reduce intraocular pressure (IOP) via creation of direct access to Schlemm's canal.

Setting:

S.V. Malayan Opthalmology Centre, Yerevan, Armenia

Methods:

This prospective study by the Micro-Invasive Glaucoma Surgery (MIGS) Study Group enrolled 53 subjects with OAG on 2 ocular hypotensive medications (one a prostaglandin) and with preoperative intraocular pressure (IOP) of 18-30 mmHg on medication and 22-38 mmHg after medication washout. Qualified subjects underwent standalone implantation of 2 second-generation trabecular bypass stents (iStent inject) followed by initiation of topical travoprost on postoperative Day 1. Study assessments include IOP, ocular hypotensive medication usage, best-corrected visual acuity (BCVA), adverse events, and findings from slit-lamp, gonioscopy, and fundus/optic nerve examinations. All subjects have been followed through 30 months (M30); longer follow-up is continuing.

Results:

Mean preoperative medicated IOP is 19.7 mmHg and post-washout IOP is 24.9 mmHg. Medicated IOP at M30 is 11.7 mmHg and unmedicated IOP at M25 post-washout is 16.5 mmHg. Postoperative mean medicated IOP remained at or below 13.0 mmHg at all visits through M30. At M24 92% of subjects had IOP �â�‰�¤15 mmHg on 1 medication and all had IOP �â�‰�¤18 mmHg. 94% of subjects achieved a decrease in IOP �â�‰�¥20% on 1 medication vs. preoperative IOP on 2 medications. Favorable safety was observed, including stable BCVA, cup-to-disc ratio, and visual fields.

Conclusions:

Findings in this evaluation of second-generation stents (iStent inject) implanted ab internally as a sole procedure are encouraging. In this cohort of eyes with OAG on 2 preoperative glaucoma medications, implantation of 2 second-generation trabecular stents combined with a postoperative topical prostaglandin demonstrated clinically meaningful IOP and medication reduction and favorable safety through 30 months.

Financial Disclosure:

receives consulting fees, retainer, or contract payments from a company producing, developing or supplying the product or procedure presented

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