Eyeworld

Sponsored content INDICATION FOR USE. The iStent inject® W Trabecular Micro-Bypass System Model G2-W is indicated for use in conjunction with cataract surgery for the reduction of intraocular pressure (IOP) in adult patients with mild to moderate primary open-angle glaucoma. CONTRAINDICATIONS. The iStent inject W is contraindicated in eyes with angle-closure glaucoma, traumatic, malignant, uveitic, or neovascular glaucoma, discernible congenital anomalies of the anterior chamber (AC) angle, retrobulbar tumor, thyroid eye disease, or Sturge-Weber Syndrome or any other type of condition that may cause elevated episcleral venous pressure. WARNINGS. Gonioscopy should be performed prior to surgery to exclude congenital anomalies of the angle, PAS, rubeosis, or conditions that would prohibit adequate visualization of the angle that could lead to improper placement of the stent and pose a hazard. MRI INFORMATION. The iStent inject W is MR-Conditional, i.e., the device is safe for use in a specified MR environment under specified conditions; please see Directions for Use (DFU) label for details. Sponsored by PRECAUTIONS. The surgeon should monitor the patient postoperatively for prop- er maintenance of IOP. The safety and effectiveness of the iStent inject W have not been established as an alternative to the primary treatment of glaucoma with medications, in children, in eyes with significant prior trauma, abnormal anterior segment, chronic inflammation, prior glaucoma surgery (except SLT performed > 90 days preoperative), glaucoma associated with vascular disorders, pseudoex- foliative, pigmentary or other secondary open-angle glaucomas, pseudophakic eyes, phakic eyes without concomitant cataract surgery or with complicated cataract surgery, eyes with medicated IOP > 24 mmHg or unmedicated IOP < 21 mmHg or > 36 mmHg, or for implantation of more or less than two stents. ADVERSE EVENTS. Common postoperative adverse events reported in the iStent inject® randomized pivotal trial included stent obstruction (6.2%), intraocular inflammation (5.7% for iStent inject vs. 4.2% for cataract surgery only), secondary surgical intervention (5.4% vs. 5.0%) and BCVA loss ≥ 2 lines ≥ 3 months (2.6% vs. 4.2%). CAUTION: Federal law restricts this device to sale by, or on the order of, a physician. Please see DFU for a complete list of contraindications, warnings, precautions, and adverse events. ©2020 Glaukos Corporation. Glaukos and iStent inject are registered trademarks of Glaukos Corporation. Copyright 2020 ASCRS Ophthalmic Corporation. All rights reserved. The views ex- pressed here do not necessarily reflect those of the staff and leadership of EyeWorld and ASCRS, and in no way imply endorsement by EyeWorld and ASCRS. Furthering the point, John Berdahl, MD, discussed iStent inject W in the context of ocular surface disease and quality of life. Dr. Berdahl described a study of nearly 50 patients who had iStent or iStent inject implanted at the time of cataract surgery. Three months postop, the OSDI score went from severe to mild, staining was significantly reduced from baseline, and tear film break-up time was 49% longer. 1 "We think that's due to reducing the number of medications patients were on," Dr. Berdahl said. iStent inject W is one of the smallest known devices implanted into the human body, occupying only 2% of Schlemm's canal, leaving 98% untouched. "There is nothing more stealth than two devices that each occupy only 1% of the canal," said Thomas Samuelson, MD, adding later, "It's minimally disruptive, more so than any other incisional glaucoma procedure we have to offer." For surgical technique, Dr. Williamson said the same principles for angle procedures apply: Turn the patient's head away 25 degrees or more, tilt the microscope toward you 35 degrees or more, adjust the seat or table as needed, and adjust your body to ensure comfortable access. Dr. Williamson also stressed the importance of gonioprism practice, using a light touch to prevent corneal folds. Glaukos' iPrism ® SX has a tri- pod approach that allows for mobility of the eye along with visualization. As for the insertion, the technique is nearly the same as with iStent inject. Dr. Bedrood reviewed her iStent inject data, finding a mean IOP reduction from 18.4 mm Hg at baseline to 13.3 mm Hg 6 months postop. At 6 months, 78% of these patients had pressures of 15 mm Hg or lower, and 93% were 18 mm Hg or lower. "For those of you who are on the fence, waiting to get into MIGS, or maybe you tried MIGS several years ago and didn't have the best experience and are waiting for a more intuitive device that you can trust to help your patients and make them happy, this is the device for you," Dr. Williamson said. To view the full webinar, go to bit.ly/2KygPD7. Reference 1. Baartman B. Ocular surface disease changes after iStent or iStent inject implantation with phacoemulsification. Presentation at the 2020 ASCRS Virtual Annual Meeting. Physicians discuss early experience with Glaukos' enhanced dual-stent system in launch webinar W hen people think MIGS, they think iStent ® (Glaukos). "For all of us, I think iStent devices have been the go-to that we use for MIGS," said Iqbal "Ike" Ahmed, MD. "The evolution I've seen from the first-generation iStent, to the iStent inject, and now the iStent inject W is a transition into making the procedure more predictable—more predictable IOP results, more predictable in confidence and placement, and more predictable reducing risks and uncertainties." In October, Glaukos introduced the third-generation iStent inject W "built on the proven foundation of two-stent trabecular micro-bypass tech- nology," according to Blake Williamson, MD. "iStent inject W delivers the performance you've come to expect with iStent inject with added benefits." These benefits include: • safe and effective control of your patient's glaucoma; • optimized stent visualization while maintaining a truly microscale footprint; • streamlined implantation; and • procedural predictability. Most notable about the iStent inject W is the stent's wider flange diameter of 360 µm (compared to the prior 230 µm design). This feature increases stent visibility and contributes to the overall predictable nature of this procedure, Dr. Williamson said. A new injector design also has several enhancements to better facilitate stent implantation. Sahar Bedrood, MD, PhD, provided specifics on patient selection. The iStent inject W is for patients undergoing cataract surgery who have mild to moderate primary open angle glaucoma. "It's especially good for those who have trouble instilling drops or who struggle with tolerance, adherence, or cost. Or if a patient is taking a drop and not having any problems, I still want to try to get them off that drop because we know the burden it can have on the ocular surface." MIGS ENHANCED: Introducing iStent inject ® W PM-US-0314

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