ASCRS 2024: A retrospective study shows iStent's impact on medication burden in surgical and non-surgical patient groups

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At ASCRS, Dr Rom Kandavel discusses iStent outcomes for patients who have undergone laser peripheral iridotomy, trabeculectomy and SLT

At this year's ASCRS meeting, we caught up with Rom Kandavel, MD, of Colvard-Kandavel Eye Center in Los Angeles, California. He discussed the paper he presented at the meeting, which focused on IOP lowering and medication burden for patients who received the iStent inject.

Editor's note: The below transcript has been lightly edited for clarity.

Rom Kandavel, MD: Thank you so much for allowing me to speak today, I was able to present a paper at this year's ASCRS meeting in regards to the 12-month data following patients who received the iStent inject who had surgery previously or no surgery previously. And what we did is we did a retrospective study, and we collected about 100 patients. There were 34 patients who receive previous surgery. The surgery that we defined was laser peripheral iridotomy, selective laser trabeculoplasty (SLT) and trabeculectomy. And when we looked at those patients, and we looked at the medication burden, as well as the intraocular pressure, we were able to see a significant trend for improvement after iStent inject placement at the 12-month mark.

In fact, the surgical group started out with lower intraocular pressures but more medication burden. And the non surgical group, as being less severe glaucoma, were maintained at a higher pressure. So they had a higher starting pressure. In the end, they had less medications. Therefore, we saw a significant reduction in IOP in both groups. The prior surgical group started at 15.85 and ended at 13.2 average, at the 12 month mark. The non surgical group had started at 17.12 and then ended at 13.84. But when we looked at medication burden, the prior surgical group had started on average about 1.82 medications, but ended at 1.34. However, the non prior surgical group started out with 1.32 and ended at 1.3. And that was not statistically significant.

But what we did see was that when patients received a iStent inject despite having a baseline pressure that was different ended up with the same mean pressure at the 12 month mark. Similarly, patients who had the iStent inject in the surgical group versus the non surgical group enjoyed around a 35% independence from drops at the 12 month mark. So a similar amount of medication free treatment after the iStent inject in two dissimilar groups, one surgical, one non surgical. So there's really good evidence, I think, in this study, to at least, you know, talk about using iStent inject in previous patients with laser peripheral iridotomy as well as SLT and trabeculectomy.

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