• Written By: John Hovanesian, MD
    Cataract/Anterior Segment

    This prospective study found that patients who underwent combined single trabecular micro-bypass stent and cataract surgery had significantly better unmedicated IOP control through 24 months than patients treated with cataract surgery alone.

    The approval of the iStent has ushered in a new era in our field. To me, microinvasive glaucoma surgery is a game-changer like premium implants were 10 years ago, altering the way every ophthalmologist should think about surgery.  

    The authors randomized 239 patients with mild to moderate glaucoma and an unmedicated IOP between 22 mmHg and 36 mmHg to cataract surgery with trabecular micro-bypass stent (iStent, Glaukos) implantation or cataract surgery alone.

    At two years, mean IOP was stable in the stent group, while it increased in the control group from 17.0 ± 3.1 mmHg at 12 months to 17.8 ± 3.3 mmHg at 24 months. Additionally, more patients in the stent group achieved an IOP of 21 mmHg or lower without medication compared with the control group (P = 0.036). Both groups had a similar favorable long-term safety profile.

    Furthermore, the mean number of medications used was significantly lower in the stent group at 12 months; it was also lower at 24 months, although the difference was no longer statistically significant.

    In general, the mean corneal thickness remained unchanged in both groups through the 24-month follow-up, and the majority of patients showed an improvement in CDVA and maintained this improvement through two years.

    The authors conclude that the potential to achieve a target IOP with a lower medication burden is an unmet need for this elderly population. Based on these findings, iStent implantation appears to be a therapy that can be provided at the time of cataract surgery in patients with cataract and mild to moderate glaucoma.