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Treatment with standalone implantation of two trabecular micro-bypass stents combined with topical prostaglandin in OAG on two preoperative medications: 5 year outcomes

Poster Details

First Author: A.Jünemann GERMANY

Co Author(s):                        

Abstract Details


To prospectively assess safety and IOP following standalone implantation of two trabecular bypass stents (iStent®) combined with topical travoprost started 1 day postoperative in eyes with OAG not controlled on 2 ocular hypotensive medications. Topical prostaglandin was chosen for its potential to reduce intraocular pressure (IOP) through a different outflow pathway than the stents.


The study was conducted by a subset of the MIGS study group physicians. All surgeries and follow-up visits were completed at the S.V. Malayan Ophthalmological Center in Yerevan, Armenia.


This prospective, single-arm, unmasked study enrolled subjects with OAG on 2 preop topical medications. Preoperative mean medicated IOP was 18-30 mmHg and post-washout mean unmedicated IOP was 22-38 mmHg. Subjects were implanted with 2 iStent devices as a standalone procedure, and travoprost was started on postoperative day 1. Annual medication washouts were conducted to assess unmedicated IOP. Efficacy and safety assessments included IOP, medication usage, slit-lamp examination, gonioscopy, fundus/optic nerve evaluation, BCVA, and adverse events (AE).


Thirty-seven of 39 subjects enrolled completed 5-year follow-ups. Postoperative mean medicated IOP showed consistent reduction to ≤14.0 mmHg at all visits through M60, and was 12.4 mmHg at M60 compared to 22.4 mmHg preop. Postop mean unmedicated IOP was ≤17.7 mmHg at all visits, and was 16.6 mmHg at M60 compared to 25.3 mmHg preoperative. At M60, IOP ≤18 mmHg on travoprost was observed in 88% of subjects. All subjects underwent uncomplicated implantation with 2 iStent devices with no device-related AEs. Reported AEs include progression of pre-existing cataract (5 eyes) and trabeculectomy (one eye) due to glaucoma progression.


This report builds upon previously published work demonstrating favorable outcomes with iStent implantation for the treatment of OAG. Treatment with 2 iStent devices combined with topical travoprost can safely achieve significant and sustained reduction of IOP to ≤14 mmHg and reduced medication burden through 5 years postoperative. These findings are encouraging and suggest that standalone implantation of multiple iStent devices may be an effective treatment modality for patients with OAG.

Financial Disclosure:

receives consulting fees, retainer, or contract payments from a competing company

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