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Digital Supplement | Sponsored by Glaukos

Hand-in-Hand: MIGS & Advanced Refractive Cataract Surgery

Microinvasive glaucoma surgery (MIGS) and advanced refractive cataract surgery can go hand-in-hand, as each provide benefits to surgical outcomes, postoperative vision, and patient lifestyle. In particular, the iStent inject offers a great marriage when performing refractive cataract surgery. Concomitant laser cataract surgery and iStent inject allow the potential for our patients to reduce their need for bifocals as well as glaucoma drops after surgery.

This surgical video demonstrates laser cataract surgery with a toric lens in addition to iStent inject implantation. I use the iPrism S gonioscopy lens from Glaukos to gain a widefield view of the surgical field. After zooming in, I’ve dimpled down the trocar into the trabecular meshwork pushing slightly into position (Figure 1). I depress the stent delivery button to deploy the first stent. I move 2 to 3 clock hours away from the first stent and deploy the second.

Figure 1. iStent inject placement in the trabecular meshwork.

I love the idea of combining iStent inject with refractive cataract surgery (Figure 2). For the patient, the combined cataract and iStent inject procedure should have a positive influence on the patient’s lifestyle by potentially reducing medication burden and lowering IOP.

Figure 2. Postoperative image after concomitant laser cataract surgery with toric lens implantation and iStent inject.

1. Guedes RAP, Gravina DM, Lake JC, et al. Intermediate results of iStent or iStent inject implantation combined with cataract surgery in a real-world setting: a longitudinal retrospective study. Ophthalmol Ther. 2019;8(1):87-100.

Blake Williamson, MD, MPH, MS
  • Cataract, Glaucoma, Refractive Surgeon, Williamson Eye Center, Baton Rouge, Louisiana
  • blakewilliamson@weceye.com
  • Financial disclosure: Glaukos