Real-World Comparison Of Standalone Or Combined Istent Inject Vs Istent Inject W Implantation Over 12 Months

The purpose of this study was to compare the efficacy and safety of the iStent inject W to its precursor the iStent inject when inserted in combination with phacoemulsification (phaco) or as a standalone procedure over 12 months. Outcomes included intraocular pressure (IOP), number of IOP-lowering medications, and post-operative complications.

Single surgeon (RL) at the University Hospital in Erlangen, Germany.

Retrospective, non-randomized single center study. Patients underwent either standalone (57 cases) or combined phaco (147 cases) insertion of iStent inject (n = 91 patients) or iStent inject W (n = 113 patients). The majority (63%) of participants had a diagnosis of primary open-angle glaucoma (POAG), while the remaining patients were diagnosed with the following glaucoma subtypes: pseudoexfoliation (31%), pigment dispersion (2%), normal-tension (3%) or other (1%). Patients with juvenile glaucoma, angle closure glaucoma, or impending angle closure were excluded. No medication washout was performed. Outcomes were compared using the Mann-Whitney U test for statistical significance.

In all groups, both iStent inject and iStent inject W significantly reduced IOP (p < 0.001) from baseline. In the standalone groups, IOP was reduced from 18.80 ± 4.06 mmHg to 15.26 ± 4.97 mmHg after 12 months with iStent inject, and from 19.91 ± 4.77 mmHg to 16.5 ± 5.12 mmHg with the iStent inject W. In the combined phaco group, iStent inject insertion lowered IOP from 18.63 ± 5.00 mmHg at baseline to 14.71 ± 3.96 mmHg after 12 months, and from 19.74 ± 7.23 mmHg to 14.43 ± 3.36 mmHg with iStent inject W. Medication burden was significantly reduced (p < 0.05) in all groups except for the standalone iStent inject group, though markedly greater reduction in medications was noted in the combined phaco group. Safety in all groups was excellent.

In conclusion, both the iStent inject and the iStent inject W significantly reduced IOP when implanted as either a standalone procedure or in combination with phacoemulsification. Overall, these real-world data indicate that both iterations of the iStent inject are effective and safe surgical options for a broad patient population.