Trabecular microbypass stents as minimally invasive approach after conventional glaucoma filtration surgery

Abstract

Purpose: To evaluate long-term efficacy and safety of 2 trabecular microbypass stents in patients with advanced primary open-angle glaucoma (POAG) and insufficient intraocular pressure (IOP) after previous filtration surgery.

Setting: Vivantes Klinikum Neukölln, Augenklinik, Berlin, Germany.

Design: Retrospective case series.

Methods: Eyes with uncontrolled and advanced POAG since 2014 were assessed. All eyes previously had at least 1 filtration surgery procedure. The anatomical landmarks and configuration of the anterior chamber angle had to be identified easily. Two iStents were placed nasally into Schlemm canal.

Results: The study comprised 42 patients (42 eyes); 18 eyes had 1 previous glaucoma filtration surgery. During the follow-up of 12 months, the mean IOP in cases of primary failure of filtration surgery decreased from preoperative 23.8 mm Hg ± 3.9 (SD) to 15.2 ± 2.7 mm Hg. For cases with more than 1 previous filtration surgery, the mean IOP decreased from preoperative 26.1 ± 5.7 mm Hg to 16.3 ± 3.3 mm Hg. Medications were reduced from 2.7 ± 0.9 to 2.0 ± 1.1. No intraoperative or perioperative complications occurred.

Conclusions: For eyes with previous filtration surgery and medically uncontrolled IOP, the implantation of 2 stents provided a minimally invasive and safe reduction of mean IOP to less than 18 mm Hg at 12 months. The number of medications was also reduced.