Evaluation of the Efficacy and Safety of Canaloplasty and iStent Bypass Implantation in Patients with Open-Angle Glaucoma: A Review of the Literature

The aim of the paper was to evaluate the efficacy and safety of minimally invasive antiglaucoma procedures: Canaloplasty and iStent bypass implantation with and without phacoemulsification in patients with primary open-angle glaucoma (POAG). A systematic review of the recent literature was performed based on the PubMed, Google Scholar, Web of Science and Scopus databases. The effectiveness of the procedures was evaluated based on the reduction of intraocular pressure (IOP) and the amount of antiglaucoma medication used before and after surgery. Safety of the treatments was evaluated based on the number of incidences of certain intraoperative and postoperative complications. Independent prospective randomized controlled trials (PRCTs) have demonstrated that both procedures, canaloplasty and iStent implantation, are effective in reducing IOP and the amount of antiglaucoma medication. Considering the safety profile of these procedures, both canaloplasty and iStent implantation are associated with low rates of postoperative complications and have similar safety profiles. Further studies are needed to confirm the results of our analysis, including a high-quality randomized controlled trial comparing canaloplasty and iStent bypass implantation

Evaluation of the Effect of the First Generation iStent on Corneal Endothelial Cell Loss-A Match Case-Control Study

Glaucoma is the leading cause of irreversible blindness worldwide. The only proven factor in slowing the progression of glaucomatous neuropathy is lower intraocular pressure (IOP), which can be achieved with pharmacology, laser therapy, or surgery. However, these treatments are associated with various adverse effects, including corneal endothelial cell loss (CECL). In recent years, several novel surgeries for reducing the IOP, collectively referred to as minimally invasive glaucoma surgery (MIGS), have been developed, one of which is the iStent. However, the long-term effects of such surgeries remain unknown. We compared a group of patients with open-angle glaucoma and cataract who underwent phacoemulsification alone with a group of patients with similar demographic and clinical characteristics who underwent simultaneous phacoemulsification and iStent implantation. Overall, 26 eyes of 22 subjects who underwent a combined phacoemulsification-iStent procedure and 26 eyes of 24 subjects who underwent cataract surgery were included. Before surgery, endothelial cells accounted to 2228.65 ± 474.99 in iStent group and 2253.96 ± 404.76 in the control group (p = 0.836). After surgery, their number declined to 1389.77 ± 433.26 and 1475.31 ± 556.45, respectively (p = 0.509). There was no statistically significant difference in CECL between the two groups 18–24 months after surgery, despite increased manipulation in the anterior chamber and the presence of an implant in the trabecular meshwork in those with an iStent implant. Thus, iStent bypass implantation is a safe treatment in terms of CECL for mild-to-moderate open-angle glaucoma.