iStent® for Microtrabecular Bypass

What is the iStent®?

The iStent® procedure involves a small titanium implant that is placed during minimally invasive glaucoma surgery to help lower eye pressure, ultimately treating open angle glaucoma.

Inside a person’s eye, a fluid called aqueous humor is constantly produced and drained out of the inner eye (this is a different fluid and different fluid system than the tears that circulate on the outside of a person’s eye). In most types of glaucoma, there is an imbalance between fluid production and fluid drainage inside the eye, which causes the pressure inside the eye to rise. Glaucoma eye drops are designed to lower eye pressure by either decreasing fluid production or improving fluid drainage. Similar to many types of glaucoma eye drops, the iStent® microtrabecular bypass device helps lower eye pressure by improving the drainage of aqueous fluid out of the eye through its natural drainage system.

What is involved with the iStent®?

The iStent® is the smallest medical device ever approved by the FDA and is designed to treat mild-to-moderate open-angle glaucoma during cataract surgery procedures. A benefit of the iStent® procedure is that it is typically easily combined with cataract surgery and results in minimal manipulation or damage of normal eye tissue. The iStent® is typically easier to perform, faster to recover from, and safer than traditional glaucoma surgeries.

Clinical trials have demonstrated that patients who had cataract surgery combined with iStent® placement had better pressures and required fewer eye pressure lowering drops, when compared with patients who had cataract surgery alone. The iStent® may help reduce a patient’s medication burden, reducing the cost, inconvenience, or side effects of using eye drops. The iStent® may also help delay or avoid the need for more risky surgical interventions in the future.

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What are the risks of the iStent®?

The main risks of the iStent® procedure are similar to the risks associated with standard cataract surgery such as inflammation, infection, retinal tears or detachment. Risks unique to the iStent® procedure include:

  • It is normal to have some bleeding at the site of the iStent® insertion. The bleeding from the iStent® is typically mild and not problematic. Occasionally, bleeding can be significant, causing a delay in visual recovery or a rise in eye pressure, but these issues are typically short-lived and managed with topical eye medications.
  • The iStent® may become obstructed by the iris or other tissue inside the eye. This may be treated with medications, laser, or may inhibit the iStent®’s function.
  • Rarely, the iStent® can dislocate. Reports indicate that the device is so small and well tolerated, that it can remain undisturbed wherever it migrates, or the device could be repositioned or removed from the eye (requiring a second surgical procedure).
  • The iStent® may fail to change or improve the eye pressure, requiring continued drops or other interventions for glaucoma.

In patients with higher eye pressures, using several eye drops, or with more advanced glaucoma, multiple iStent® devices may be inserted into the eye, though most insurances only cover the cost of one. The procedure may also be combined with the endocyclophotocoagulation laser (ECP laser). ECP is a glaucoma laser than can reduce the amount of fluid produced in the eye, a complementary procedure to the iStent® that is designed to improve the drainage of fluid from the eye. These surgical options will be considered by your doctor and can be discussed further at the time of your appointment.

If you are ready to schedule your appointment to learn the best method for treating your glaucoma, please contact our practice today.


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