Significant IOP reduction after combined phacoemulsification and micro-invasive glaucoma surgery (MIGS)

Abstract

In a controlled clinical trial, we investigated long-term results after trabecular micro-bypass stent implantation in routine cataract surgery in eyes with chronic open angle glaucoma. Combined phacoemulsification and trabecular micro-bypass implantation proved to be an effective and safe treatment method to reduce intraocular pressure, reducing the burden on local drug treatment. Implantation offers a good option for additional pressure reduction. Microsurgical procedures to reduce intraocular pressure, which are minimally traumatic and are performed ab interno and characterized by efficiency, a high safety profile and a rapid healing process, should be used more frequently. Since decades, trabeculectomy is the gold standard in glaucoma surgery. Recently trabecular stents bypass the compromised trabecular meshwork, creating a direct route from the anterior chamber into Schlemm’s canal and improving aqueous outflow. In a prospective randomized clinical study, we investigated the long-term results, safety and efficacy of trabecular micro-bypass stent implantations as part of a routine cataract surgery in eyes with mild to moderate chronic open-angle glaucoma. In combined surgeries, phaco PC-IOL plus trabecular micro bypass implantation, has shown reasonable efficacy in lowering IOP and the necessary IOP reducing medications. Our results showed a favorable benefit-to-risk profile. canal. Examples are the iStent and the iStent inject. Both stents are implanted while being guided by gonioscopy into Schlemm’s canal. This is located at the level of the pigmented trabecular meshwork at the border to the non-pigmented trabecular meshwork. Suprachoroidal stents, such as the CyPass Micro-Stent (currently removed from the market), conduct the aqueous humor into the suprachoroidal space. The CyPass Micro-Stent is implanted more deeply, far below Schlemm’s canal, into the supraciliary space. Stents for use in the subconjunctival space are, for example, the XEN gel implants, which are implanted far above Schlemm’s canal, directly below the Schwalbe line, into the non-pigmented trabecular meshwork. The operating principle of subconjunctival outflow is similar to a small trabeculectomy. iStent inject is a trabecular micro-bypass system with two preloaded implants made of heparin-coated, non-ferromagnetic titanium. The implants are very small. At 360 µm x 230 µm, they are the smallest medical devices used in humans. They have two ends; at one end, the inlet opening protrudes into the anterior chamber, while the other end opens out into the Schlemm’s canal in a pointed conical shape wifth four lateral outlet openings. The middle part of the stent