iStent® Trabecular Micro-bypass

iStent® Trabecular Micro-bypass

iStent® Trabecular Micro-bypass is a minimally invasive surgical treatment for the management of open angle glaucomas.

The iStent® is the first minimally invasive FDA-approved implantable device for the treatment of open angle glaucomas. The iStent ® is a Micro-Invasive Glaucoma Surgery (MIGS) approved to be done in conjunction with cataract surgery. Since it is done at the same time as cataract surgery, no additional incisions are necessary. The surgical procedure involves placement of a tiny 1mm long titanium device through the trabecular meshwork and into Schlemm’s canal to enhance aqueous outflow from the anterior chamber and lower intraocular pressure. Although the iStent® is made of titanium, patients can safely undergo MRI scans in most circumstances; please contact our office with any questions or visit the iStent® MRI Safety page.

This procedure does not involve opening up the conjunctival tissues to access Schlemm’s canal. This is a major advantage of this procedure as it makes future glaucoma surgery (if needed) a lot simpler with less risk of failure.

Who is a good candidate for iStent® Trabecular Micro-bypass?

iStent® is indicated for the surgical treatment of mild to moderate open angle glaucomas. It is contraindicated in patients with primary or secondary angle closure glaucoma, neovascular glaucoma, patients with thyroid eye disease, retrobulbar tumors, Sturge-Weber Syndrome, and/or any other condition causing elevated epislceral venous pressure.

How does the iStent® Trabecular Micro-bypass work?

The iStent® reduces IOP by increasing outflow through the trabeculocanalicular outflow pathway. It increases the flow of aqueous humor from the anterior chamber, directly into Schlemm’s canal, and out through the collector channels. This procedure does not create a ‘bleb’ on the surface of the eye as fluid is routed through normal physiological pathways.

For more details visit the iStent® website.

What is involved with an iStent® Trabecular Micro-bypass procedure?

When you and your doctor make a decision to proceed with an iStent® you will meet with our preoperative scheduler who will give you detailed instructions on how to prepare yourself for your upcoming surgery and what is involved in getting to the operating room for the procedure. See Preoperative instructions for more information.

This is an outpatient procedure performed in an ambulatory surgery center. In most cases, the surgery takes about 1 hour, though you will be at the surgery center for about 3 hours. The surgery is usually done under local anesthesia with intravenous sedation. After surgery, the eye is covered by an eye patch and protected by a plastic shield overnight. On the morning following the surgery, the patch/shield is removed and the eye is examined by your ophthalmologist. Eye drops are then prescribed to prevent infection and reduce inflammation. For more details, click on Postoperative instructions.

For several weeks following the surgery, your ophthalmologist will observe your eye closely and examine you frequently. It may take up to 12 weeks after your surgery for the healing to be complete. During this time it is not unusual for your intraocular pressure, as well as vision, to fluctuate. You will be ready to change your glasses prescription at around 6-8 weeks after surgery.