ASCRS 2024: Third-generation trabecular micro-bypass in eyes failing prior glaucoma therapy

Deborah Gess Ristvedt, DO, shared highlights of her ASCRS presentation with Ophthalmology Times and what these real-world cases mean for clinicians and their patients with glaucoma.

Video Transcript

Editor’s note - The following transcript has been lightly edited for clarity.

Deborah Gess Ristvedt, DO:

Hi, I'm Dr. Deb Ristvedt from Vance Thompson Vision in Alexandria, Minnesota. The newest standalone device available to us is now iStent infinite, which involves 3 device implants, really affording us more multidirectional outflow. We know that 2 stents were better than 1 and now we're looking at how 3 stents are performing compared to 2.

And so I looked at my first 50 patients this last year and how they did in real-world life. These were all standalone cases, half of them had had prior surgery, whether it was prior Xen implantation, whether it was a goniotomy with canaloplasty, or prior SLT and Durysta. And half of my patients were on maximum medical tolerated medical therapy, and they were uncontrolled. When you pull all these 50 patients together, the mean IOP preoperatively was 16.9 mm Hg being on 2.2 medications or more. And so we looked at how they did afterwards and how they're doing today at 12 months.

It's exciting to see the data when you're dealing with patients that are anywhere from moderate glaucoma to severe glaucoma and how that makes a difference in real-world life. What we're finding is that maybe we don't get pressures in the 10 to 12 range but postoperatively the mean average was 16.7 from 16.9.

What is so interesting about our data is 86% of patients were dropfree at 1 year, which is huge when we're talking about compliance...how drops work? Well, you got to take them and so are we seeing progression more and more because we're not getting that 24-hour IOP control. And so not only are we looking at the disease state and the severity and what we can do over time, since we know glaucoma is not curable.

But we're also looking at quality of life reducing dry eye symptoms, and really helping these patients in life when it comes to the use and how we're using eye drops.