Combining MIGS With Implant Lowers IOP in Glaucoma

Overview

Combining iStent Infinite trabecular microbypass stents with cataract surgery significantly lowers intraocular pressure (IOP) and reduces the need for topical glaucoma medications. The addition of the iDose TR intracameral travoprost implant further enhances IOP reduction and increases the proportion of patients achieving medication-free status.

Background

Glaucoma progression is often inadequately controlled by topical medications due to compliance issues, side effects, and complex regimens. Minimally invasive glaucoma surgery (MIGS) offers a proactive alternative to improve patient outcomes and quality of life. The iStent Infinite device is designed to reduce IOP by improving aqueous outflow, and the iDose TR implant provides sustained-release travoprost to further lower IOP. Combining these interventions with cataract surgery may optimize glaucoma management.

Data Highlights

Key Findings

• Both surgical approaches significantly reduced IOP and topical medication use over 3 to 6 months.
• iStent Infinite with cataract surgery reduced mean IOP by 1.9 mmHg and increased medication-free eyes from 8% to 54%.
• Adding iDose TR to iStent Infinite and cataract surgery further lowered IOP by 2.6 mmHg and increased medication-free eyes from 26% to 88%.
• The proportion of patients achieving IOP less than 10 mmHg was higher with the addition of iDose TR (44% vs 29%).
• No treatment-related adverse events were reported in either group.
• A small number of patients required subsequent trabeculectomy, indicating the need for individualized patient management.

Clinical Implications

Incorporating iStent Infinite with cataract surgery offers a meaningful reduction in IOP and decreases reliance on topical medications, potentially improving adherence and quality of life. The addition of the sustained-release iDose TR implant enhances these benefits, increasing the likelihood of achieving low target IOP and medication-free status. These combined MIGS approaches represent effective, proactive strategies for managing open-angle glaucoma.

Conclusion

Combining trabecular microbypass stents with cataract surgery, with or without the iDose TR implant, significantly lowers IOP and reduces topical medication burden. The addition of iDose TR further improves outcomes, supporting its role in comprehensive glaucoma management.

References

1. Feulner LK, 2026 ASCRS Annual Meeting -- Combining MIGS With Implant Lowers IOP in Glaucoma