The randomised controlled trial (RCT) carried out by the iStent study group is the largest RCT to date. This article is based on previously conducted studies and does not involve any new studies of human or animal subjects performed by any of the authors.Ĭlinical picture of an iStent implanted in the angle In this article we will describe the principle current glaucoma micro-implants, the currently available evidence underpinning their use, and how they may fit into future practice. Such new aqueous drainage devices can be classified on the basis of the targeted aqueous outflow pathway: via Schlemm’s canal, via the suprachoroidal space, or via the subconjunctival space. There has been particular interest recently in developing tubular stents, comprised of various materials, which can lower pressure in a similar manner to existing glaucoma drainage devices, but without the associated risks or the time-consuming and involved surgical procedure. The term “minimally invasive glaucoma surgery” (MIGS) has arisen to describe such procedures however, there is no widely accepted definition of MIGS, and thus no consensus on which specific procedures the term encompasses. There is interest in finding surgical options that reduce surgical time, have an easily reproducible technique, and which are accessible to all ophthalmologists who manage glaucoma patients, rather than being the preserve of glaucoma specialists. These techniques and devices embrace the common theme of not only being effective in reducing intraocular pressure (IOP) and medication burden but also in causing as little trauma as possible to the target tissue, and most importantly they are safe. Over the last decade there has been significant activity in developing novel surgical treatments for glaucoma.
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