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Two iStent injects and topical travoprost reduce IOP, medication use through 18 months
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The implantation of two second-generation iStent inject devices and postoperative topical prostaglandin in eyes with open-angle glaucoma reduced mean IOP and medication use at 18 months, according to a study.
The prospective, nonrandomized, open-label study included 53 patients with open-angle glaucoma and preoperative IOP of 18 mm Hg to 30 mm Hg on two medications; IOP ranged from 22 mg to 38 mm Hg after medication washout. The patients were implanted with two iStent inject devices (Glaukos) and received postoperative topical travoprost. Patients were followed for 18 months, and medication washout was repeated at month 12.
The primary outcome of the study was a reduction of IOP by 20% compared with medicated baseline IOP and a reduction of at least one medication at 12 months.
At 1 year, IOP was reduced by 20% or more in 91% of eyes with a reduction of one medication. Also, 100% of eyes had an IOP of 18 mm Hg or less with a reduction of one medication and 87% had IOP of 15 mm Hg or less.
The mean medicated IOP for all patients through 18 months was 12.9 mm Hg, or a 37% reduction from the preoperative baseline. No adverse events were observed in the 18-month study. – by Robert Linnehan
Disclosures: Berdahl reports he received financial support from Glaukos for his work as an investigator in this study. Please see the study for all other authors’ relevant financial disclosures
Perspective
Back to TopNathan Radcliffe, MD
We are now well into the era of microinvasive glaucoma surgery (MIGS) and Dr. John Berdahl and colleagues have recently published an impressive study describing the placement of two second generation MIGS implants (iStent inject, Glaukos) along with topical travoprost. The placement of two stents is conceptually appealing because the canal of Schlemm is not always contiguous, and because having a stent proximal to collector channels may benefit outflow. In this prospective 18-month study, 91% of patients achieved the primary outcome of 20% reduction in IOP, with 87% of patients having an IOP below 15 mm Hg. Because the unmedicated baseline IOP was 25 mm Hg, this represents a significant pressure reduction with a manageable once daily medication schedule after surgery. The safety profile was highly favorable, as one would expect. What was particularly impressive about this study is the fact that cataract extraction was not performed, and therefore significant pressure reduction may be attributed to the trabecular bypass stents. Because we have a terminal washout at 13 months, we know that the stents alone reduced the IOP by 33%. Indeed, MIGS is moving forward, and impressive results are following.
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Berdahl J, et al. Clin Exp Ophthalmol. 2017;doi:10.1111/ceo.12958.
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