What is iStent Inject® Implant Surgery?

The goal of all glaucoma surgeries is to lower eye pressure safely and effectively.

The iStent Inject® implant is part of a new group of surgeries classified as "Minimally Invasive Glaucoma Surgery" (MIGS). The iStent Inject® is a very small titanium tube that is introduced into the eye through a micro incision and injected into the structure of the eye where natural drainage occurs, called the trabecular meshwork.

What is the purpose of the surgery?

The iStent Inject® Implant Surgery is used to reduce and better control intraocular pressure. It can also be used to reduce or possibly eliminate the number of glaucoma eye drops or medications for patients who are having difficulty tolerating the medication(s) or for patients who have good intraocular pressure with medication but who would prefer to eliminate or minimize their use of eye drops. However, we cannot guarantee that you will not need eye drops after surgery. Other considerations for this procedure can be discussed with your doctor, as each patient has their own particular needs.

iStent Inject® Implant Surgery is usually done in combination with cataract surgery, or as a stand-alone surgery in patients who have already had cataract surgery.

How can such a small device reduce the pressure of the eye?

The trabecular meshwork is the natural pathway for drainage of the aqueous humour. The iStent Inject® implant helps the fluid to bypass this structure to improve outflow and lower the pressure inside the eye.

Can the iStent be used in all patients with glaucoma?

Glaucoma is a disease with many causes and manifests differently in each patient. For this reason, not all surgeries are advisable for all glaucoma patients. iStent Inject® Implant Surgery is usually offered to patients with mild to moderate open-angle glaucoma. It may also be used for patients with advanced glaucoma to lower the eye pressure further and avoid the risk of more invasive surgeries. It is not advisable for uveitic glaucoma, neovascular glaucoma and angle closure glaucoma (with some exceptions). It is advised that you discuss surgical options with your ophthalmologist.

Why choose the iStent Inject® Implant Surgery over other surgical options?

Each type of surgery comes with different success rates and also different types of potential complications. The iStent Inject® implant surgery is less invasive and takes less time than other glaucoma surgeries. Compared to other glaucoma surgeries, iStents generally require less postoperative visits and a shorter healing period. The iStent can also be less effective than other glaucoma surgeries in lowering intraocular pressure. If you need stronger pressure lowering, you may require a different type of glaucoma surgery.

Are these surgical devices covered by Manitoba Health?

Unfortunately, iStents are not covered by the WRHA, therefore GEM Clinic surgeons can only offer them if a patient pays for them.

Do I need to stop my blood thinner medication before or after the surgery?

No. Due to the minimally invasive nature of the surgery, it is not necessary to stop your blood thinners.

After surgery, will I still need to take glaucoma medications?

You may or may not need to continue your glaucoma medications after surgery. This depends on the stage of your glaucoma, the number of medications you are taking before surgery, what your target pressure is and how effective the implant is at lowering your pressure after surgery. Your surgeon will tell you if you need to restart some of your glaucoma drops at your follow-up visits.

Is the surgery painful? Will I feel the implant in my eye?

The surgery is usually done as an outpatient day surgery under local anesthetic with minimal conscious sedation. In general, the surgery is comfortable and painless.

Because of the location and small size of the implant, you will not be able to feel the implant in your eye after surgery. You may feel a slight scratchy feeling the day of surgery from the incision (and stitch, if one is required).

Are there any risks involved?

During the surgery, a limited and small amount of bleeding can occur but is usually unremarkable and clears up quickly. In rare cases, there can be risk of infection and/or inflammation. Your ophthalmologist will prescribe antibiotic and anti-inflammatory eye drops to be taken after your surgery that will prevent infection and facilitate healing.

Can I resume my normal activities after surgery?

As with all intraocular surgeries, there is a period of time where some postoperative restrictions are advised. After the iStent Inject® implant surgery, you should refrain from heavy lifting and strenuous activity (including straining from constipation) for one week. You should refrain from swimming for two weeks after surgery. Depending on your vision and if you were able to drive before the operation, you will likely be able to drive 48 hours afterwards. Avoid any appointments to the dentist the first 2 weeks after surgery (as dirty matter can spray into your eye and cause an infection).

B221-2025 Corydon Avenue, Winnipeg, Manitoba, Canada, R3P 0N5

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