Micro-bypass stent reduces IOP, medications in combined cataract procedure

CHICAGO — When implanted with a micro-bypass stent after combined cataract surgery, uncontrolled primary open-angle glaucoma patients showed significantly reduced IOP and medication use, a clinician said here.

E. Randy Craven, MD, presented 1-year results of a 2-year multicenter prospective study of the iStent trabecular micro-bypass stent (Glaukos) at the American Society of Cataract and Refractive Surgery meeting. He explained that the iStent functions by bypassing the trabecular meshwork to reach Schlemm's canal.

"In looking at how this [stent] worked with the combination cataract-glaucoma procedure, it did allow us to have a reduced drug burden with pressure reduction at a year out, and it's a way of looking at bypassing the blocked trabecular meshwork," Dr. Craven said.

So far, 53 eyes of 59 enrolled subjects have completed at least 12 months of follow-up. Subjects underwent clear cornea phacoemulsification with ab interno gonioscopically guided implantation of the iStent, Dr. Craven said.

Subjects had a mean baseline pressure of 21.5 mm Hg, with a mean 1.7 medications used at baseline. After surgery and implantation of the device, the mean IOP was 17.4 mm Hg and mean medications used dropped to 0.6, he said.

There were some complications, including seven cases of stent lumen obstruction, six cases in which the stent touched the iris and three cases in which trabeculectomy was performed, Dr. Craven said.