This article was originally published in a sponsored newsletter.
As glaucoma surgeons, keeping up with new devices in the micro-invasive glaucoma surgery space has continued to enhance our ability to tailor our approaches to treatment. It is vital that we keep up with what’s coming down the pipeline. Recently, that has included the iStent infinite Trabecular Micro-Bypass from Glaukos, an upgraded change to a multi-stent device with a unique injector system. My early experience with the device has been positive and patients have been satisfied.
The iStent infinite contains three stents (one more than the previous iStent inject W system). Ergonomically, the redesigned inject or system has an 8° angled insertion tube, which I have found helps to improve stent delivery. Perhaps the most innovative change is that there is no limit to the number of times stents can be deployed. With the iStent infinite, surgeons can rethread and inject as many times as necessary, which is a significant benefit.
Patients have done well in both cataract surgery and standalone procedures. While it is still early, I have seen an approximate 8 mmHg to 12 mmHg pressure reduction in my patients.
The learning curve is straightforward with this device. If you’ve worked with a previous-generation iStent device, you’ll be comfortable with iStent infinite. In fact, because of the upgrades to the design, this device is more straightforward to use than previous options.
For best visualization during the procedure, I recommend using Glaukos’ disposable gonioscopic lens because it has a wide angle. You can benefit greatly from the broad angle of this lens as you insert the infinite’s three stents, two to three clock hours apart from each other.
I believe surgeons will find this device to be a nice addition to their toolbox. Because we can use it as a standalone procedure, it provides an option for patients who do not require cataract surgery, who may also be headed toward an invasive filtering surgery. That’s a nice step forward for intraocular pressure control.
