The iStent: Small Wonder

The iStent (Glaukos), one of the newer options for minimally invasive glaucoma surgery, has become increasingly popular for glaucoma patients who at the same time suffer from visually significant cataracts. This procedure is a great option for patients ready to have cataract surgery who also have early to moderate open-angle glaucoma. Ideal candidates are those already on one to three glaucoma drugs whose Intraocular Pressure (IOP) – the target pressure in patients with glaucoma are in the mid-teen range, have compliance issues and/or want to decrease using drops for managing their glaucoma.

This procedure has several advantages. First, when compared to traditional glaucoma surgical procedures, it’s minimally invasive, with a faster operative time, more rapid healing and fewer complications. The procedure is contact lens wearer-friendly. That said, this procedure does have some disadvantages. The iStent indication is limited to implantation in combination with cataract surgery, as opposed to a stand-alone procedure. Although the implant is very small, placing a foreign object into the eye does introduce the potential risk of intraoperative complications, e.g., if the device is malpositioned and the tip becomes occluded by iris or if the device becomes dislodged. Postoperatively, there can be IOP spikes and hyphema. Also, because it is a fairly new procedure, it is considered experimental and not currently covered by many commercial insurances, although it does have excellent Medicare coverage. Preoperatively, candidates require a full glaucoma and cataract work up with ancillary testing. Blood thinners should be stopped preoperatively if possible. Post-op care is the same as traditional cataract surgery. Patients should be aware that their vision may be blurred for the first few days due to the mild bleeding during the surgery.