Reduction in Intraocular Pressure Fluctuation after Trabecular Micro-Bypass Implantation: Case Report

Introduction:To present a case of a patient with advanced glaucoma and documented intraocular pressure (IOP) fluctuations who underwent iStent inject implantation, resulting in reduced pressure variability and stabilization of visual field progression. Symptoms and Clinical Findings:A 65-year-old female with a single functional eye and progressive glaucomatous damage despite apparently well-controlled IOP on dual therapy underwent a water drinking test (WDT), revealing significant IOP fluctuations as a probable cause of the glaucomatous progression. Therapeutic Interventions and Outcomes:Given the patient's monocular state and the surgical risks associated with filtering procedures, it was decided, in agreement with the patient, to perform an iStent inject implantation in an attempt to control the IOP fluctuations.Following surgery, the patient demonstrated a significant flattening of IOP fluctuations on repeat WDT, from a range of 10-19 mmHg preoperatively to 10-13 mmHg postoperatively.Hypotensive therapy was reduced, and serial 24-2 visual fields have shown stabilization during the 22 months since her surgery. Conclusion:This case suggests that iStent inject may be a valuable treatment option to reduce IOP fluctuations in carefully selected patients at high surgical risk.Further studies are needed to explore the potential role of minimally invasive glaucoma surgery (MIGS) in the management of IOP variability.