Retrospective analysis of indications and outcomes of trabecular micro-bypass stent implantation in Indian eyes

Purpose: To analyze the patient characteristics, initial outcomes, and complications associated with iStent implantation in Indian eyes. Methods: This retrospective case series comprised subjects who underwent iStent, iStent inject, or iStent inject W implantation as a standalone procedure or combined with phacoemulsification with at least 12 months follow-up. The main outcome measures were change in intraocular pressure (IOP) and number of anti-glaucoma medication (AGM), post op complications, and resurgery rates at the final follow-up. Results: A total of 56 eyes of 46 patients were included. Twenty-six eyes received iStent, and 30 eyes received either iStent inject or iStent inject W. Mean IOP reduced by 25.5%, and the mean number of AGM decreased by 75.8% at final follow-up ( P < 0.005). The overall success rate was achieved in 51 eyes (85%). When compared to standalone iStent, combined phacoemulsification with iStent delivered greater reduction in AGM ( P = 0.004). Compared to iStent, eyes with iStent inject and inject W had better IOP reduction ( P = 0.03), lesser AGM ( P < 0.005), and a lesser number of surgical failures ( P = 0.045). Three months after iStent inject implantation, trabeculectomy was performed in one eye with secondary glaucoma. Postoperative IOP rise due to steroid response was observed in 20 eyes (35.7%). Conclusion: iStent implantation in Indian eyes demonstrated promising outcomes in reducing both intraocular pressure and anti-glaucoma medication burden. While combined procedures exhibited superior efficacy in reducing IOP and AGM, postoperative complications such as steroid-induced IOP rise were observed, emphasizing the importance of careful monitoring and management in optimizing surgical outcomes.