iStent Effective in Severe Glaucoma

■ Glaukos Corporation said a study published in the Journal of Glaucoma showed that a single iStent Trabecular Micro-Bypass Stent implanted during cataract surgery in patients with severe open-angle glaucoma achieved mean postoperative IOP of 14.1 mmHg and a 28% reduction in the mean number of glaucoma medications used after 36 months of follow-up.

The retrospective case series included 59 glaucomatous eyes with cataracts and severe visual field loss. At baseline, the medicated mean IOP was 19.3 mm Hg and the mean number of topical glaucoma medications used per eye was 2.3. In 49 eyes followed for 24 months after iStent implantation and concomitant cataract surgery, mean postoperative IOP decreased to 14.9 mmHg while the mean number of glaucoma medications used per eye declined to 1.6. In a consistent cohort of 32 eyes with available data through 3 years postoperatively, the IOP reduction was maintained. At 3 years, this cohort achieved a mean postoperative IOP of 14.1 mmHg, from a baseline mean medicated IOP of 18.1 mmHg, and a 28% reduction in mean glaucoma medications used per eye from 2.44 preoperatively to 1.75.

“While many prior studies have documented the clinical benefits of combining iStent implantation with cataract surgery in glaucoma patients who are in the mild to moderate stage of the disease, we believe this is the first published study to focus on its use in severe glaucoma patients undergoing cataract surgery,” said John Berdahl MD, one of the article’s authors. “Our study showed that severe glaucoma patients experienced sustained reductions in IOP and medication use through 3 years postoperative.” According to the study authors, no intraoperative complications were noted. Among the 59 eyes in the series, 4 required additional surgery.