Mesa 2.03: Actualización iStent inject – Glaukos
Over the past two decades, micro-invasive glaucoma surgery (MIGS) has gained an increasing role in glaucoma treatment, in particular in patients with earlier stages of the disease. Available MIGS treatment options have expanded greatly since the first MIGS device was introduced, the iStent trabecular micro-bypass (Glaukos Corporation, San Clemente,CA, USA; FDA 2012; CE 2004). A large body of peer reviewed evidence for a durable reduction in IOP and medication burden, combined with favorable safety profile is available.
In 2018 the the second-generation iStent inject trabecular micro-bypass (Glaukos) which includes two trabecular stents implanted ab interno through the trabecular meshwork into Schlemm’s canal was approved by the FDA. In some countries in Europe for example Germany the second generation system was available even earlier.
Several controlled studies have evaluated iStent inject implantation as a standalone procedure or combined with phacoemulsification in mild to moderate glaucoma. In both settings a clinically meaningful IOP reduction as well as a reduction of medication burden was shown.
At the academic ophthalmology center in Heidelberg, Germany a real-world cohort of patients with various types of glaucoma and substantial preoperative disease burden underwent implantation oft two iStent inject either combined with phacoemulsification or as a standalone procedure. Patients have already been followed up for 36 months postoperatively, and follow up is ongoing.
The analysis of these prospective, non randomized case series confirmed the findings of the controlled studies:
In real-life with various types of glaucoma, including mild, moderate as well as severe disease stages MIGS with trabecular micro-bypass stents is a valid treatment option for long term IOP- and medication reduction along with a favorable safety profile.