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MIGS reduces IOP after failed trabeculectomy
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MIGS surgery via iStent injection can provide IOP reduction in advanced adult primary and secondary open-angle glaucoma after failed trabeculectomy. Glaucoma therapy needs to be maintained to achieve individual target pressure to prevent glaucoma progression, however, according to researchers.
In the retrospective study, the iStent (Glaukos Corp.) was implanted in 22 eyes of 21 patients with glaucoma with an IOP above target pressure after failed trabeculectomy.
Researchers found a significant IOP decrease from 22.5 mm Hg to 15.5 mm Hg after 1-year follow-up.
Glaucoma therapies per patient were reduced from 2.6 preoperatively to 2.25 after 1 year. The researchers concluded that glaucoma therapy needs to be maintained to achieve an individual target pressure and to prevent progression.
Six subjects dropped out of the study because their IOP did not reach target pressure.
“An accurate implantation of the iStent through the trabecular meshwork into Schlemm’s canal is crucial for the functionality of this device,” the researchers wrote.
The most common complication was intraoperative blood reflux, which occurred in 90.9% of eyes. In 27.3% of patients there was an additional need for glaucoma surgery, according to researchers. – by Abigail Sutton
Disclosures: The researchers reported no relevant financial disclosures.
Perspective
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Carl H. Jacobsen, OD, FAAO
Glaucoma patients who fail trabeculectomy are a troubling group. Most proceed to this procedure after failed medical and laser intervention, so it is often a patient’s final option. What happens when the final option fails?
Davids and colleagues address this question by performing minimally invasive glaucoma surgery (MIGS) on patients who have failed trabeculectomy. Their findings? One year after iStent implantation IOP was reduced from a mean of 22.5 mm Hg to 15.5 mm Hg. Too good to be true? Maybe. The authors are quick to state that there was a significant dropout rate (27.3%) due to failure to meet IOP targets after implantation. These data certainly would have blunted the positive result. Also, this is a small retrospective study, with only 22 eyes enrolled. More rigorous scientific studies are needed.
Despite these limitations, I find this study encouraging. It’s heartening to know that there is a possibility of IOP-lowering success via MIGS in a population that is largely out of options. In my practice, MIGS has failed to impress, but it’s early days. The technology is developing, and the surgeons are becoming more adept at implantation. I’ll keep an open mind to this promising intervention as we move forward.
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