One-Year Outcomes of Second-Generation Trabecular Micro-Bypass Stents (iStent Inject) Implantation with Cataract Surgery in Different Glaucoma Subtypes and Severities

Abstract

To assess the 1-year efficacy and safety of the implantation of two second-generation trabecular micro-bypass stents (iStent Inject®) with concomitant cataract surgery in various subtypes and severities of glaucoma. This single-surgeon, consecutive case series from a Canadian academic ophthalmology center included subjects with cataract, glaucoma, and the need to reduce intraocular pressure (IOP) and/or medications. The 12-month outcomes included mean IOP and medication burden as well as the proportions of eyes with IOP\u2009≤\u200918,\u2009≤\u200915, and\u2009≤\u200912 mmHg compared to baseline. Other measures included corrected distance visual acuity (CDVA), cup-to-disc ratio (CDR), visual field mean deviation (VF MD), retinal nerve fiber layer (RNFL) thickness, ganglion cell inner plexiform layer (GCIPL) thickness, and adverse events. In 118 eyes, mean IOP reduced from 17.00\u2009±\u20093.82 mmHg preoperatively to 13.97\u2009±\u20092.65 mmHg at the 12-month follow-up mark (17.8% reduction, p\u2009<\u20090.001), and mean medication burden decreased from 2.31\u2009±\u20091.33 preoperatively to 1.03\u2009±\u20091.10 medications (56% reduction, p\u2009<\u20090.001). After 12 months, 93% of eyes achieved IOP\u2009≤\u200918 mmHg (versus 69% preoperatively), 70% of eyes achieved IOP\u2009≤\u200915 mmHg (versus 42% preoperatively), and 29% of eyes achieved IOP\u2009≤\u200912 mmHg (versus 7% preoperatively). For all eyes, topical medications were either maintained or decreased from baseline, with ≥\u20091 medication eliminated from the preoperative regimen for 83% of eyes and ≥\u20092 medications eliminated for 36% of eyes. Visual acuity improved significantly, consistent with expectations for cataract surgery, while CDR, VF MD, and RNFL and GCIPL thicknesses remained stable. Safety was favorable, with no intraoperative complications and few transient adverse events postoperatively. iStent Inject implantation with cataract surgery safely reduced IOP and medication burden in a real-world clinical population with mild to severe glaucoma, and stabilized visual field, as well as RNFL and GCIPL thicknesses on OCT. The Rapid Service Fees were funded by Glaukos Corporation.