iStent Inject®

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.

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.

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.

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.

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

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

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.

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).

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.

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).