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Scientific article
English

A prospective analysis of iStent inject microstent implantation: surgical outcomes, endothelial cell density, and device position at 12 months

Published inJournal of Glaucoma, vol. 29, no. 8, p. 639-647
Publication date2020
Abstract

Precis: The surgical outcome of iStent inject devices is associated with device protrusion within the anterior chamber. Schlemm canal (SC) dilatation has a prognostic value. iStent inject devices do not move within the first year after implantation. Introduction: The iStent inject is a device designed to be implanted ab-interno through the trabecular meshwork. The present study follows up on our preliminary report, using successive in vivo anterior segment optical coherence tomography (AS-OCT) imaging to analyze the associations between stent positioning, iridocorneal angle structures, and surgical outcomes. Methods: In total, 54 eyes of 42 patients (73.3 +/- 7.4 y) with cataract and mild-to-moderate open-angle glaucoma were examined in this prospective study. All patients underwent implantation of 2 iStent inject devices combined with phacoemulsification. Patients were followed up over a 12-month period. AS-OCT was performed after 3 and 12 months. Thirty unoperated fellow eyes served as control eyes. Results: Intraocular pressure (IOP) decreased from 16.5 +/- 4.2 mm Hg at baseline to 15.1 +/- 3.7 mm Hg at 12 months (-8.7%;P=0.004), while medications decreased from 1.8 +/- 1.0 to 0.5 +/- 0.9 (-72.2%;P<0.001). Unmedicated IOP <= 18 mm Hg was achieved in 58.8% of operated eyes. No sight-threatening complications were reported. On AS-OCT, 44.9% of devices were buried within the trabeculum. Device position was unchanged between scans. Regression analysis elicited significant predictors: SC dilatation effect [risk ratio (RR)=0.230;P=0.003], greatest SC diameter (RR=0.991;P=0.049), extrusion of the most anterior device (RR=0.993;P=0.012), gonioscopically visible devices (RR=0.406;P=0.040), baseline treatments (RR=2.214;P=0.001), and baseline IOP (RR=0.184;P=0.006). Endothelial cell density decreased by 14.6% at 12 months (P<0.001). Conclusions: This study demonstrates the IOP-lowering and medication-lowering potential of iStent inject surgery in primary open-angle and pseudoexfoliative glaucoma. It confirms that surgical outcomes are positively associated with device protrusion within the anterior chamber, and suggests SC dilatation effect as a favorable prognostic indicator. It shows that stents are stable in time, highlighting the importance of the initial implantation location.

Keywords
  • Aged
  • Anterior Eye Segment/diagnostic imaging
  • Cell Count
  • Endothelium
  • Corneal/pathology
  • Female
  • Glaucoma Drainage Implants
  • Glaucoma
  • Open-Angle/physiopathology/surgery
  • Gonioscopy
  • Humans
  • Intraocular Pressure/physiology
  • Low Tension Glaucoma/physiopathology/surgery
  • Male
  • Middle Aged
  • Phacoemulsification
  • Prospective Studies
  • Prosthesis Implantation
  • Stents
  • Tomography
  • Optical Coherence
  • Tonometry
  • Ocular
  • Trabecular Meshwork/surgery
Affiliation Not a UNIGE publication
Citation (ISO format)
GILLMANN, Kevin et al. A prospective analysis of iStent inject microstent implantation: surgical outcomes, endothelial cell density, and device position at 12 months. In: Journal of Glaucoma, 2020, vol. 29, n° 8, p. 639–647. doi: 10.1097/IJG.0000000000001546
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Article (Published version)
accessLevelRestricted
Identifiers
ISSN of the journal1057-0829
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Creation01/14/2021 11:56:00 AM
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Update time03/15/2023 11:52:55 PM
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