Third-Generation Trabecular Micro-Bypass In Eyes Failing Prior Surgical And/Or Medical Glaucoma Therapy

The newly-approved 3rd-generation three-stent trabecular micro-bypass device, iStent infinite, can be implanted either with or without cataract surgery. The current study assessed consecutive cases of standalone iStent infinite implantation from a U.S. glaucoma surgeon in patients who had failed prior surgical and/or medical intervention. 

Multi-specialty ophthalmology private practice in the United States.

This non-randomized, retrospective, unmasked, consecutive study included all cases of standalone iStent infinite implantation in patients who had failed prior surgical and/or medical glaucoma treatment. Intraocular pressure, medications (meds), adverse events, and secondary surgeries were evaluated preoperatively and through 9 months postoperatively; 15-month data and a larger sample size will be available by the time of the conference. 

All patients (n=31 eyes) were implanted with 3 iStent infinite stents, with no intraoperative complications.  Most eyes (25/31 or 81%) had undergone one or more prior glaucoma surgery(ies), predominantly Xen, Durysta, and/or laser trabeculoplasty; the remaining eyes were using maximum-tolerated medical therapy (MTMT). Mean IOP reduced from 17.2±5.8mmHg preoperatively (n=31) to 14.1±3.9mmHg at 9 months (n=10) (18% reduction, p=0.221); mean # meds reduced from 2.26±1.32 to 0.60±1.26 (73% reduction; p=0.045).  Nearly all MTMT eyes (5/6) were med-free at the time of last follow-up (ranging 1 week to 9 months).  No postoperative adverse events or secondary surgeries occurred.

iStent infinite implantation yielded meaningful IOP and med reductions through 9 months in eyes that had failed prior glaucoma surgery(ies) and/or MTMT, with favorable safety.