Real-world study finds iStent infinite lowers IOP and reduces the need for topical medication in patients with glaucoma
Zachary Vest, MD, a glaucoma specialist at the Mile High Eye Institute in Denver, Colorado, spoke with Ophthalmology 360 at the American Society of Cataract and Refractive Surgery Annual Meeting about a study that found 1 year after iStent infinite implementation, half of patients were on less medications for their glaucoma.
Zachary Vest, MD:
We are presenting our data on the 12-month outcomes of iStent infinite, which included both standalone and POAG cases. It was a 12-month retrospective review. We included 7 surgeons from 6 sites, so we looked at over 380 cases. Out of those 380 cases, we had data on 135 cases that made it out to 12 months, so we looked at that as a constant cohort of patients.
The outcomes showed that we had approximately a pre-op pressure of 17 mm of mercury. Patients were on a little over one and a half medications. At that 1-year mark, patients were approximately 14 mm mercury on approximately 1 medication. When we looked at all of those patients combined, the outcome showed that approximately half of patients were able to be on less medications than they were preoperatively. When we looked at those results as well, when we talk about pressure reduction, approximately half of patients had a 20% reduction from their preoperative pressure with an iStent infinite implantation.
When we looked at all 385 patients, essentially looking for secondary surgeries complications, there were no documented complications or secondary interventions directly from the implant itself. However, there were 5 patients that did need secondary interventions either to decrease their medication burden or to help lower pressure, but those were 3 cases of SLT, 2 cases of Durysta, and there was 1 patient who did undergo a zen needling, but none of those were direct complications from the iStent itself.
Future studies we’d like to carry this data out further, certainly to look at more long-term results. This is obviously very early data for an implant that we’ve only had access to for several years, and so hopefully we can pull that out to a longer time point and give us a little bit more granularity on which patients do well, which patients are most successful. We have, in that data set, like many MIGS surgeries, a subset of patients who do extremely well. Approximately 15% of patients had a 40% reduction in their IOP. Ultimately trying to tease out that information would be helpful. Also, our average intraocular pressure started out much lower than most comparative controlled trials. Seeing how those lower intraocular starting pressures perform in this MIGS space is also helpful as that’s not the traditional recruitment patient for these studies.
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