en
Scientific article
Case report
English

Anterior segment optical coherence tomography signs of local dilatation effect of a micro-stent on Schlemm's canal

Published inNepalese Journal of Ophthalmology, vol. 10, no. 20, p. 184-187
Publication date2018
Abstract

Introduction: The iStent inject (R) (Glaukos Corporation, CA, USA) is a relatively new device designed to be implanted ab-interno through the trabecular meshwork. This is, to the best of our knowledge, the first in-vivo description of a trabecular bypass device visualised with anterior segment optical coherence tomography (AS-OCT), and report of its structural effect on Schlemm's canal. Case Report: A 74 year-old female patient suffering from long-standing primary open-angle glaucoma and nuclear sclerosis underwent cataract surgery combined with the implantation of two iStent injects (R). Surgery was uncomplicated and achieved intraocular pressure (-1 mmHg) and medication (-2 molecules) reduction at 6 months. Under AS-OCT (Spectralis OCT, Heidelberg Engineering AG, Germany) the stent appears as a 300 mu m long hyperreflective hollow device within the trabecular meshwork. Approximately a third of it protruded into the anterior chamber. Profound OCT signal loss was notable within the shadow of the device. A second AS-OCT section 500 mu m beside the microstent shows a markedly dilated Schlemm's canal, with a major diameter of 390 mu m. Discussions: This report confirms that AS-OCT is a suitable technique to assess microstent positioning, and provides a first report on the in-vivo appearance of a functioning stent. It also indicates that iStent injects (R) could have a tangible effect on adjacent portions of Schlemm's canal with, in this case, a 220% increase in canal diameter compared to the observed average (122 mu m). This suggests the IOP-lowering effect of trabecular bypass devices could rely on a dual mechanism involving Schlemm's canal dilatation.

Keywords
  • Aged
  • Female
  • Glaucoma
  • Open-Angle/physiopathology/surgery
  • Humans
  • Intraocular Pressure/physiology
  • Prognosis
  • Prosthesis Failure
  • Stents/adverse effects
  • Tomography
  • Optical Coherence/methods
  • Trabecular Meshwork/diagnostic imaging/surgery
Affiliation Not a UNIGE publication
Citation (ISO format)
GILLMANN, Kevin et al. Anterior segment optical coherence tomography signs of local dilatation effect of a micro-stent on Schlemm’s canal. In: Nepalese Journal of Ophthalmology, 2018, vol. 10, n° 20, p. 184–187. doi: 10.3126/nepjoph.v10i2.23030
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Article (Published version)
accessLevelRestricted
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ISSN of the journal2072-6805
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