In the past, glaucoma and cataract surgery were two separate procedures. In 2012 the FDA approved a device called the iStent Trabecular Micro-Bypass Stent System to treat symptoms of glaucoma. This is the first device that has been approved in conjunction with cataract surgery to reduce intraocular pressure (IOP) in adult patients with mild or moderate open-angle glaucoma and a cataract who are currently on IOP medication. However other devices are in various stages of develoipment and testing.
The smallest device ever approved by the FDA (0.5mm x 1mm), iStent is so tiny that you cannot see it or feel it—it's about the size of a third of a grain of rice. iStent creates a permanent opening in your trabecular meshwork and helps improve the flow of fluid from your eyes to regulate IOP. Among many advantages, iStent:
- Protects eye tissue that often gets damaged by traditional surgeries.
- Can be safely implanted during cataract surgery.
- Has a rapid recovery time.
- Allows for future treatment options for preserving vision.
You should continue using any prescribed eye drops until your operation, unless directed by your doctor. Your surgeon will go over all your medications, especially if you take blood thinners such as Coumadin. Bring a list of your current medications and a brief medical history to your pre-operative appointment.
During the Sugery
The cataract removal and iStent procedure is usually performed under local anesthesia. Your surgeon will first perform the phacoemulsification procedure to remove the cataract. With an ultrasonic device, the cloudy lens is broken up and removed and an artificial intraocular lens (IOL) is inserted. Using the same incision, the titanium iStent will be inserted by a preloaded, single-use, sterile applicator. Your surgeon will slowly advance the iStent into the trabecular meshwork of your eye and push the button on the inserter to release the iStent. The cataract removal and iStent implant only take about 15 to 20 minutes per eye.
After the Surgery
iStent is an outpatient procedure, and you can go home the same day. After the surgery, your eye may be covered by an eye shield that you can remove the following morning. You will receive antibiotic and anti-inflammatory eye drops to use for the next four to six weeks. Most likely, you will see your ophthalmologist the following day.
Recovery time is quite quick, but your doctor may recommend that you take an entire week off from work. You should refrain from strenuous activities like sports, lifting heavy objects or straining as this will increase your eye pressure.
The iStent device has proven to lower IOP as much as 2.4 to 9 mm HG when combined with cataract surgery. The iStent procedure does not increase the risk of cataract procedure and both are extremely safe. More than six percent of iStent patients have been able to discontinue glaucoma drops after surgery so there is a good chance you may be able to discontinue your glaucoma drops after this procedure.