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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


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.


S.V. Malayan Opthalmology Centre, Yerevan, Armenia


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.


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.


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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