New iStent Glaucoma Implant Now Available In Our Clinic

The iStent Trabecular Micro-Bypass Stent is a new surgical option in the treatment of glaucoma. It is a form of Minimally Invasive Glaucoma Surgery (MIGS). Measuring 1mm in length, it is the smallest medical device used in humans.

What Does the iStent Do?

The iStent creates a permanent opening that bypasses the blockage in the drainage system to improve the eye’s natural fluid outflow. This reduces the eye pressure to prevent damage to the nerve at the back of the eye, thus preventing blindness.

Is it Effective in Lowering Eye Pressure? Is it Safe to Use?

This implant is approved by the US Food & Drug Administration (FDA) and the Health Sciences Authority (HSA) in Singapore. More than 1million iStents have been used in glaucoma patients in USA and Europe with good results in lowering eye fluid pressure and an excellent safety profile.

Clinical studies have shown that patients who received the iStent implant experienced between 16-40% (4 – 10mmHg) reduction in eye fluid pressure. These patients also had a substantial reduction in the number of glaucoma eyedrops they required, with some of them not needing eyedrops anymore. In addition, the complications arising from iStent in conjunction with cataract surgery were similar in number and severity to cataract surgery alone.

Who Should Undergo the Surgery?

The iStent  is indicated in patients with Open Angle Glaucoma  and can be implanted at the same time that a person is undergoing cataract surgery. It can also be used in those who previously had cataract surgery. While conventional forms of glaucoma surgery are suitable for patients with advanced glaucoma, the iStent implant can be used in those with mild and moderate glaucoma with:

1. Eye pressure inadequately controlled with eyedrops and/ or laser treatment
2. Adverse/ allergic  reactions to eyedrops

Being minimally invasive, the advantages of iStent surgery over conventional glaucoma surgery are:

1. Fewer complications
2. Shorter recovery time
3. Greater patient comfort
4. Conventional glaucoma surgery can still be performed in future if needed

Our Glaucoma Specialist is trained to perform iStent surgery in suitable patients as a Day Surgery procedure.

Selected References

• Voskanyan L et al. Prospective, unmasked evaluation of the iStent inject system for open-angle glaucoma: synergy trial. Adv Ther 2014; 31: 198-201
• Craven ER et al. Cataract surgery with trabecular micro-bypass stent implantation in patients with mild-moderate open angle glaucoma and cataract: two year follow-up. J Cataract Refract Surg 2012; 38: 1339-45
• Samuelson TW et al. Randomised evaluation of the trabecular micro-bypass stent with phacoemulsification in patients with glaucoma and cataract. Ophthalmology 2011; 118: 459-467
• Fea AM. Phacoemulsification vs phacoemulsification with micro-bypass stent implantation in POAG: randomised double masked clinical trial. J Cataract refract Surg 2010; 36: 407-12
• Patel I et al. Manchester iStent Study: early results from a prospective UK case series. Clin Experiment Ophthalmol 2013; 41: 648-52
• Arriola-Villalobos P et al. Mid-term evaluation of the new Glaukos iStent with phacoemulsification in coexistent open-angle glaucoma or ocular hypertension and cataract. Br J Ophthalmol 2013; 97: 1250-55
• Arriola-Villalobos P et al. Combined iStent trabecular micro-bypass stent implantation and phacoemulsification for co-existent open-angle glaucoma and cataract: a long term study. Br J Ophthalmol 2012; 96: 645-9
• Kim L et al. iStent trabecular micro-bypass stent for open angle glaucoma. Clin Ophthalmol 2014; 8: 1937-45