Combined cataract surgery-iStent imparts ocular surface benefits
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Combined treatment of cataract surgery with iStent or iStent inject trabecular bypass stent showed benefits to the ocular surface and overall improvement in ocular surface disease.
“The iStent trabecular meshwork bypass stent [from Glaukos] was introduced to the market in 2012 and, as with any surgical procedure, surgical device or medication having extended, long-term data is helpful in making the best treatment decisions for our patients,” study investigator Justin A. Schweitzer, OD, FAAO, from Vance Thompson Vision in Sioux Falls, S.D., told Primary Care Optometry News.
The study involved 50 patients with mild to severe primary open-angle glaucoma who underwent cataract surgery in combination with iStent treatment. The researchers performed follow-up at 1 day, 1 week, 1 month and 3 months postoperatively and for a total of 7 years.
“Dr. Schweitzer and I recognized along with several of our colleagues on the study there was little, if any, published research on the impact of trabecular micro-bypass stent on ocular surface disease,” study investigator Whitney Hauser, OD, FAAO, director of clinical affairs for Keplr Vision, told PCON. “It stood to reason that a minimally invasive glaucoma surgery with the potential to reduce the number of glaucoma medications and/or frequency of instillation may also reduce signs and symptoms of ocular surface disease in the same patient population.
IStent implantation was successful for all patients with an overall good safety profile and no intra- or postoperative complications. At 3 months, the Ocular Surface Disease Index improved from 41.7 at baseline to 18.3. Tear film break-up time improved from 4.3 to 6.4 seconds, corneal/conjunctival staining improved from 1.4 to 0.4, and conjunctival hyperemia improved from 1.4 to 1.2 (P < .001).
Patients also showed a significant reduction in both the number of glaucoma medications (1.5 vs. 0.6; P < .001) and IOP (17.4 vs. 14.5 mm Hg; P < .001).
“Compliance with glaucoma medications is often poor,” Hauser said. “There are various reasons for poor adherence to a drop regimen including patient education level, socioeconomic barriers and other factors. Ocular surface symptoms can also be among those factors. The results of the study support that patients eligible for micro-bypass stent may experience improved ocular surface conditions after the surgery if there is a decrease in number of medications or frequency of dosing.”
Schweitzer, a PCON Editorial Board member, said that glaucoma medication use decreased by 25% at 6 years. The decrease in IOP also, “allows us clinically to educate our patients that if they have an IOP above 21 mm Hg, we like our chances of getting a significant amount of IOP lowering after placement of the stent in combination with cataract surgery.”
He noted that 4% of eyes required additional surgery, and 6% had an incidence of postoperative spike of 15 mm Hg or higher above baseline.
“This allows us clinically to educate our patients that undergoing this procedure is safe with minimal associated risk,” he said.
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Baartman BJ, et al. Ocular surface disease improvement in eyes implanted with trabecular meshwork bypass stents (iStent or iStent inject). Presented at: American Society of Cataract and Refractive Surgery meeting; May 16-17, 2020 (virtual meeting).
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