This article is more than 5 years old. Information may no longer be current.
Multiple stents with cataract surgery reduce need for IOP-lowering medications
Click Here to Manage Email Alerts
A study evaluating the efficacy of multiple trabecular micro-bypass stents combined with cataract surgery in patients with open-angle glaucoma and cataract found statistically significant reductions from baseline in both IOP and topical ocular hypotensive medication use at 1 year postoperatively. Eyes with three stents, however, required fewer IOP-reducing medications than eyes with two stents.
“There had been a fair amount of discussion and data on a single iStent implantation,” co-author and OSN Glaucoma Board Member Ike K. Ahmed, MD, said. “My colleagues and I wished to explore potential added value of additional iStents to lower pressure further.”
Study design, results
Fifty-three eyes of 47 patients were included in the study; eight eyes had mild glaucoma, 23 eyes had moderate glaucoma, and 22 eyes had advanced glaucoma. Twenty-eight eyes were implanted with two iStents (Glaukos), and 25 eyes were implanted with three iStents. Patients with severe disease were more likely to be implanted with three stents. Ahmed performed all surgeries for the study; he has approximately 4 years’ experience using the iStent, which was approved by the U.S. Food and Drug Administration in June 2012.
For both groups, mean IOP decreased significantly from 18 mm Hg at baseline to 14.3 mm Hg at 1 year. The mean number of medications also decreased significantly from 2.7 to 0.7.
Although there was no significant difference in IOP reduction between the two groups at 1 year, mean pressure reduction was greater in the three-stent group: 3.9 mm Hg vs. 3.5 mm Hg in the two-stent group.
The three-stent group required significantly fewer medications at 1 year: 0.4 medications vs. 1.0 in the two-stent group. By 1 year, medication use had been discontinued in 72% of eyes in the three-stent group compared with 46% in the two-stent group.
Minimal complications
“Based on our findings, we think that implanting two stents is a reasonable choice,” Ahmed said. “There may be some advantage with reduction of medication in the three-stent group, but there needs to be further study.”
The study did not compare a single stent with multiple stents.
“It is a very safe procedure,” Ahmed said. “We did not find any major complications or any serious consequence.”
Iris synechiae of the stent lumen was the most common complication, occurring in eight iStents during the early postoperative period, for which laser was successfully employed in six of the cases. Two iStents did not require laser treatment because of good IOP control, with a second stent patent in both cases.
The procedure can be combined with cataract surgery with minimal impact because the incisions are already made and the surgeon is already in position at the microscope, he said.
Visualization, identification of key anatomical landmarks and a proper approach angle of 30° are key for successful iStent implantation, according to Ahmed.
“For me and my practice, the iStent has caused a paradigm shift in how we select glaucoma procedures for our patients,” he said. “For surgery combined with cataract surgery, the iStent has certainly become one of our first choices, in the right patient with moderate glaucoma.” – by Bob Kronemyer