Integration Of The Glaukos Istent Device Into Glaucoma Clinical Practice At A Tertiary Hospital In Spain: A Real-World Analysis From 2010 To 2022

Purpose: To describe trends in glaucoma surgery following the implementation of the iStent, characterize the clinical profile of patients undergoing surgery, and assess changes in this profile over time.

Setting: Tertiary hospital within the Spanish National Health System.

Methods: This longitudinal study included patients who underwent iStent surgery from 2010 to 2022. Data collected included key glaucoma-related variables such as intraocular pressure (IOP), antiglaucoma medications, and structural and functional test results. Trends in surgical indications, patient characteristics, and outcomes were analyzed over time.

Results: A total of 145 eyes from 117 patients were included. iStent use increased from 3.4% of glaucoma surgeries in 2010 to 9.4% in 2022 (p < 0.001). Combined surgery was performed in 95.9% of cases, while standalone procedures accounted for 4.1%. Primary open-angle glaucoma was diagnosed in 86.2% of cases. Baseline IOP was 19.2 ± 4.5 mmHg with 1.9 ± 0.8 medications. At one year, IOP was 16.4 ± 2.5 mmHg with 0.6 ± 0.8 medications, and 53.9% of eyes were medication-free. Over time, surgeries were increasingly performed in patients with lower baseline IOP (p = 0.010) and MD (p = 0.026), achieving better postoperative IOP (p = 0.010) and prolonged time to reintroduction of medications (p = 0.026).

Conclusions: iStent is increasingly used in routine glaucoma surgeries, primarily combined with cataract surgery for mild to moderate glaucoma. Over time, surgical indications have expanded to earlier disease stages, potentially improving clinical outcomes. Its primary benefit is reducing the need for topical medications with a favorable safety profile.