iStent Trials Show Effectiveness at 5 Years

■ Glaukos Corporation said an international glaucoma study showed use of iStent Trabecular Micro-Bypass Stent during cataract surgery delivered a 38% reduction in mean IOP to 14.7 mmHg after 5 years of follow-up. The data were reported in the Journal of Cataract and Refractive Surgery.

The prospective, nonrandomized, consecutive case series included 65 eyes of 43 patients with OAG or OHT. Thirty-eight percent of eyes had undergone prior trabeculectomy and/or glaucoma laser procedures and 68% were on at least 2 preoperative medications.

Of 26 eyes followed through 5 years, a total of 92% of eyes with IOP ≤18 mmHg and 65% with IOP ≤15 mmHg, while mean medication use declined 75% to 0.5 topical ocular hypotensive medications vs 2.0 preoperatively. Approximately 69% of eyes were medication-free vs 5% preoperatively. The safety profile was favorable throughout follow-up.

Another 5-year iStent study, published in Ophthalmology Glaucoma, showed standalone implantation of 2 iStents in newly diagnosed primary open-angle glaucoma (POAG) eyes achieved a 35.3% reduction in mean IOP to 16.5 mmHg. The multicenter study evaluated the 5-year safety and efficacy of 2 iStents vs topical prostaglandin as an initial intervention in POAG subjects who had not had prior glaucoma treatment of any kind.

A total of 101 subjects were randomized in a 1:1 ratio to receive either 2 iStents in a standalone procedure or once-daily topical travoprost. At 5 years, results showed mean diurnal IOP was 16.5 mmHg for the stent group vs 16.3 mmHg (35.1% reduction) for the travoprost group, excluding eyes in both cohorts that underwent cataract surgery during follow-up. Treatment success was defined as mean diurnal IOP of 6 mmHg to 18 mmHg without add-on medication or secondary glaucoma surgery, and this was achieved in 77% of stent eyes vs 53% of travoprost eyes.