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    Glaucoma

    This retrospective case series evaluated 24-month outcomes in patients who received a trabecular microbypass stent (iStent, Glaukos Corp.) for mild to severe pseudoexfoliation (PXF) glaucoma.

    Study design

    Investigators included 115 consecutive eyes from PXF patients who underwent combined cataract surgery and unilateral stent implantation by a single surgeon. There were no exclusion criteria restricting patients based on preoperative disease severity, IOP or medication use.

    Outcomes

    At two years postoperatively, 70% of patients had reduced topical medication use from baseline, and 55% no longer required any hypotensive drops. By 1 year, mean IOP had reduced from 20.0 mm Hg preoperatively to 15.5 mm Hg (P<0.01). Patients maintained reduced IOP through the end of follow-up (14.5 mm Hg). Among patients who demonstrated an IOP of 20 mm Hg or more at baseline, 98% showed lower IOP at year 2.

    Only 1 eye required additional surgery, and no intra- or postoperative complications were observed.

    Limitations

    This study does not compare the outcomes of patients with PXF glaucoma who underwent cataract surgery alone.

    Clinical significance

    Though the FDA approval of iStent for the indication of open-angle glaucoma includes PXF as a subtype, this is the first investigation focusing specifically on effectiveness of the device in PXF eyes. These findings show that the trabecular microbypass stent may be an effective device to lower IOP and decrease dependence on topical medications in PXF glaucoma patients.