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Medication use lower 2 years after combined iStent implantation, cataract surgery
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A large observational study demonstrated that glaucoma patients implanted with the Glaukos iStent in combination with cataract surgery achieved a significant reduction in the use of topical medications over a follow-up of at least 2 years.
Nearly 3,000 patients who had undergone the combined procedure in one or both eyes were selected from a U.S. managed care network and compared with a similar number of glaucoma patients who had undergone cataract surgery alone. At baseline, 41.2% of patients in the combined group were taking no topical medications, while the rest were receiving one to three topical agents.
At month 20 to 24, this percentage rose to 64.7%. The increase was greater among patients who underwent the procedure bilaterally. For those who continued taking medications, a significant reduction of approximately one medication was reported; matched controls who underwent cataract surgery alone, however, achieved a mean reduction of 0.49 medications, and fewer patients were completely off medications.
“We note that the proportion of patients taking no glaucoma drops postoperatively steadily increased from the immediate postoperative period of months 0 to 4, through months 12 to 16, and thereafter stayed at a similar level through months 20 to 24, which may reflect the progressive discontinuation of medications after surgery as patients stop taking medications as their IOP decreases,” the authors wrote.
Glaucoma medications are often not taken regularly by the patients at home and may have adverse effects, including a negative influence on the results of future surgeries. Reducing medication dependence should therefore be regarded as a positive result, according to the authors.
Patients in this study were representative of the U.S. population at large and were treated according to their physicians’ usual practice. Therefore, “results in reduction of medication use may be more reflective of what is realistically achievable in clinical practice compared with results from randomized clinical trials,” the authors wrote. – by Michela Cimberle
Disclosures: Wang reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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John P. Berdahl, MD
This study demonstrates in a large cohort of patients that the iStent trabecular micro-bypass implant decreases the need for glaucoma medications. It provides further convincing evidence that this MIGS technology is effective in lowering IOP and helps to guide surgeons about the probability of reducing medications. This study underscores the multitude of smaller studies with similar findings and should remove questions regarding efficacy of trabecular bypass. Similar work will likely be helpful with multiple and newer-generation stents.
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