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Review
. 2014 Sep 23:8:1937-45.
doi: 10.2147/OPTH.S45920. eCollection 2014.

iStent trabecular micro-bypass stent for open-angle glaucoma

Kim Le  1 , Hady Saheb  1
Affiliations
Review

iStent trabecular micro-bypass stent for open-angle glaucoma

Kim Le et al. Clin Ophthalmol. .

Abstract

Trabecular micro-bypass stents, commonly known as iStents, are micro-invasive glaucoma surgery (MIGS) devices used to treat open-angle glaucoma. Like other MIGS procedures that enhance trabecular outflow, the iStent lowers intraocular pressure (IOP) by creating a direct channel between the anterior chamber and Schlemm's canal. iStents are typically implanted at the time of phacoemulsification for patients with open-angle glaucoma and visually significant cataracts. This review summarizes the published data regarding the efficacy, safety, and cost considerations of trabecular micro-bypass stents. Most studies found statistically significant reductions in mean IOP and ocular medication use after combined phacoemulsification with single or double iStent implantation. The devices were found to be very safe, with a safety profile similar to that of cataract surgery. Complications were infrequent, with the most common complications being temporary stent obstruction or malposition, which resolved with observation or secondary procedures. Future studies are needed to evaluate long-term outcomes, patient satisfaction, cost effectiveness, and expanded indications.

Keywords: MIGS; ab interno; glaucoma; iStent; surgery; trabecular micro-bypass.

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Figures

Figure 1
Figure 1
First-generation iStent. Notes: Copyright © 2014. Dove Medical Press. Adapted from Hunter KS, Fjield T, Heitzmann H, Shandas R, Kahook MY. Characterization of micro-invasive trabecular bypass stents by ex vivo perfusion and computational flow modeling. Clin Ophthalmol. 2014;8:499–506.
Figure 2
Figure 2
Applicator for the first-generation iStent. Notes: Reprinted from Minckler DS, Hill RA. Use of novel devices for control of intraocular pressure. Exp Eye Res. 2009;88(4):792–798. Copyright © 2009, with permission from Elsevier.
Figure 3
Figure 3
Gonioscopic view of the angle with three implanted iStents into the trabecular meshwork. Notes: Copyright © 2012. Reproduced with permission from Lippincott Williams and Wilkins/Wolters Kluwer Health, from: Saheb H, Ahmed II. Micro-invasive glaucoma surgery: current perspectives and future directions. Curr Opin Ophthalmol. 2012;23(2):96–104. Promotional and commercial use of the material in print, digital or mobile device format is prohibited without the permission from the publisher Lippincott Williams & Wilkins. Please contact journalpermissions@lww.com for further information.
Figure 4
Figure 4
Second-generation iStent inject. Notes: Copyright © 2014. Dove Medical Press. Adapted from Hunter KS, Fjield T, Heitzmann H, Shandas R, Kahook MY. Characterization of micro-invasive trabecular bypass stents by ex vivo perfusion and computational flow modeling. Clin Ophthalmol. 2014;8:499–506.
Figure 5
Figure 5
Various scanning electron microscope views of the iStent inject positioned within the trabecular meshwork (TM) and Schlemm’s canal (SC) in human anterior segment culture. Notes: Reprinted from Bahler CK, Hann CR, Fjield T, Haffner D, Heitzmann H, Fautsch MP. Second-generation trabecular meshwork bypass stent (iStent inject) increases outflow facility in cultured human anterior segments. Am J Ophthalmol. 2012;153(6):1206–1213. Copyright © 2012, with permission from Elsevier.
Figure 6
Figure 6
Three-dimensional micro-computed tomography views showing dilatation of Schlemm’s canal (SC) after implantation of the iStent inject, in relation to the trabecular meshwork (TM) and sclera (SL). Notes: Reprinted from Bahler CK, Hann CR, Fjield T, Haffner D, Heitzmann H, Fautsch MP. Second-generation trabecular meshwork bypass stent (iStent inject) increases outflow facility in cultured human anterior segments. Am J Ophthalmol. 2012;153(6):1206–1213. Copyright © 2012, with permission from Elsevier.
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