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Editors Selection IGR 24-3

Surgical Treatment: New-generation Stents

Comment by Sameh Mosaed on:

70361 Outcomes Following Implantation of Two Second-Generation Trabecular Micro-Bypass Stents in Patients with Open-Angle Glaucoma on One Medication: 18-Month Follow-Up, Lindstrom R; Lewis R; Hornbeak DM et al., Advances in Therapy, 2016; 33: 2082-2090

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This study seeks to elucidate the utility of the second generation iStent inject™ trabecular micro-bypass as a standalone procedure in the treatment of mild primary open-angle glaucoma (POAG) uncontrolled with one drop. This approach excludes secondary and non-open-angle varieties of glaucoma and isolates the effect of the newest generation trabecular micro-bypass when used separate from cataract surgery. The second- generation micro-bypass technique also deploys the use of two micro-bypass stents in each injector device unlike the standard use of a single stent with the first generation iStent™. Using this technique, the authors demonstrated that 100% of patients achieved an intraocular pressure (IOP) < 18 and IOP reduction of > 20% from baseline at one year. IOP reduction at 18 months postoperatively showed a 41% reduction in unmedicated IOP from a preoperative washout baseline. This was demonstrated with an excellent safety profile showing only one adverse event (cataract progression resulting in cataract surgery) amongst the 57 subject eyes. The study was prospective in nature, but performed unmasked in subjects of a single ethnicity. The investigators are commended for demonstrating not only the efficacy of two second-generation trabecular micro-bypass stents in lowering IOP as a stand-alone procedure, but also the additional benefits of reduced medication burden and good safety profile. The improvement in efficacy and safety may demonstrate the advantage of the second generation of trabecular micro-bypass having a less challenging implantation technique and employing more than one stent as compared to the first-generation trabecular micro-bypass.

The use of more than one stent likely allows for aqueous to access a greater number of collector channels and, therefore, a greater IOP reduction

The use of more than one stent likely allows for aqueous to access a greater number of collector channels and, therefore, a greater IOP reduction. This demonstrates a promising start in the application of stand-alone multiple second-generation trabecular micro-bypass stent use for mild POAG. The use of this technique in patients with more advanced varieties of glaucoma and secondary varieties of glaucoma remains of interest. The authors have alluded that longer-term results are forthcoming.

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