5 Years-Results Of Combined Cataract Surgery With Istent Inject® In Patients With Cataract And Open Angle Glaucoma

Over the past decade, a number of minimal invasive glaucoma surgeries (MIGS) for patients with open-angel-glaucoma (OAG) have been developed. The iStent inject® is the second generation of a surgical system for implantation of two microstents into trabecular meshwork to reduce trabecular outflow resistance. Given encouraging initial results, the question of a long-term sustainable effect on the intraocular pressure reduction remains. In this context, we report on our 5-year results with the iStent inject^® from our clinic.

All patients were treated and observed at Breyer Kaymak Klabe Augenchirurgie Düsseldorf, Germany.

The iStent inject® was used in combined surgery with phacoemulsification and intra-ocular-lens (IOL) implantation for patients with open angle glaucoma and cataract. 164 eyes of 103 patients were included into this retrospective data analysis. We monitored the development of visual acuity, intraocular pressure (IOP) and number of postoperative medications in our patients. In addition, the complication rate and necessary further other glaucoma surgery were analyzed.

164 eyes were treated, 18% of these eyes had undergone a surgical pretreatment. The mean age at surgery was 74±9 years. In the context of combined surgery, the intraocular pressure dropped significantly. A significant reduction in medication requirements was also achieved. After 5 years, IOP was 21% lower than before surgery, from 19.6±4.2 mmHg preoperatively to 15.4±1.8 mmHg. In addition, the number of concomitant medications also decreased from an average of 1.4±0.8 to 0.2±0.5.
We did not observe any serious complication. 6.7% of treated eyes had hyphema, 1.2% had hypotension and iris incarceration, and 4.3% had an iStent occlusion. Only 7 eyes (4.3%) needed a second glaucoma intervention over 5 years.

The combined surgery of iStent inject® and IOL implantation shows a moderate but long lasting IOP lowering effect and medication reduction. The iStent implantation is easy to combine with cataract surgery with minimal additional settings and instruments.
The improvement of patients adherence and quality of live due to the very low burden of additional medication are the major benefits in the treatment of patients with early to moderate OAG and cataract.