redefining o u tc o m e s in comprehensive cataract surgery

Enhancing your surgical options for patients with combined cataract and glaucoma

T he Expanding Role

of the Cataract S urgeon

With the rapid introduction of advanced technologies and techniques, the role of the comprehensive cataract surgeon continues to expand. Progressive clinical refinements, including small-incision surgery and foldable lenses, have ushered in astigmatically neutral incisions. The use of limbal relaxing incisions to treat preexisting astigmatism and the introduction of multifocal, accommodating, toric, and aspheric intraocular lenses (IOLs) have greatly improved visual outcomes for millions of patients. As new technologies are launched, comprehensive cataract surgeons continue to improve quality of life for an ever-broadening range of patients.

expand options with iStent

®

Glaucoma Management

Affecting more than 60 million people worldwide, glaucoma is the second leading cause of blindness.1 With approximately 20% of cataract cases having concomitant glaucoma and/or ocular hypertension (OHT),2 a single combined procedure that reestablishes 24-hour outflow and reduces or eliminates the need for ocular hypotensive medications is a clinically logical and cost-effective option for patients with combined cataract and glaucoma.

20% approximately

Astigmatism Management

Refinements in incision architecture and size, as well as improved phacoemulsification techniques, have created astigmatically neutral incisions. Limbal relaxing incisions and toric IOLs have given surgeons the ability to treat preexisting astigmatism.

patients with cataract and glaucoma and/or oht cataract patients

iStent is the first ab interno glaucoma stent that is used in combination with cataract surgery for the treatment of mild-to-moderate open-angle glaucoma

Presbyopia Management

The availability of multifocal and accommodating IOLs has provided patients the ability to be independent of their glasses. This has created a premium lens channel that serves patients and surgeons alike in achieving the best visual performance at near, intermediate, and far distances. Clinical advancements in comprehensive cataract care result in:

of cataract procedures per year have comorbid glaucoma and/or OHT2

• Better visual outcomes • Higher patient satisfaction • Improved quality of life

• Reduces or eliminates medication use with a comparable safety profile to cataract surgery alone3 • Reestablishes 24-hour continuous outflow3

bypass the primary source of resistance iStent bypasses the trabecular meshwork

• Maximizing outflow through Schlemm’s canal4 • Reestablishing continuous, physiological outflow4 • Increasing outflow due to the high presence of collector channels in the lower nasal quadrant5, 6 iStent Trabecular Micro-Bypass Stent Model GTS100R/L is indicated for use in conjunction with cataract surgery for the reduction of intraocular pressure (IOP) in subjects with mild-to-moderate open-angle glaucoma currently treated with ocular hypotensive medication.

iStent is 20,000 times smaller than an IOL

iStent is the smallest medical device currently approved in Canada for human use.

iStent is the next logical step in comprehensive cataract surgery

customized for optimal performance

The only commercially available device for the treatment of mild-to-moderate glaucoma

iStent dimensions are customized for a natural fit within schlemm’s canal

®

• Synergistic with cataract surgery

• Three retention arches ensure secure placement

• Inserted ab interno through the same phaco incision

• Rail design protects and accesses the underlying collector channels

• Microinvasive and astigmatically neutral • Performed under topical anesthesia • Reduces or eliminates the dependence on glaucoma medications3 • Overall safety profile similar to cataract surgery alone3 • Spares conjunctival tissue • Preserves potential for future treatment options the iStent is the smallest medical device known to be implanted in the human body

Designed for Instinctive Control

• Preloaded, single-use, sterile inserter with a secure, rotatable grip • Inserter has reacquisition capability to facilitate manipulation and placement into Schlemm’s canal • Two orientations of the iStent are available, one for the right eye (OD) and one for the left eye (OS)

• Length: 1 mm • Height: 0.33 mm • Snorkel: 0.25 mm × 120 µm (bore diameter) • Weight: 60 µg • Surgical-grade nonferromagnetic titanium • Heparin coated to promote self-priming and facilitate outflow

iStent Surgical Procedure

The iStent is inserted ab interno through the phaco incision, and can be performed under topical anesthesia.

iStent – designed for instinctive control ®

6

push the button on the inserter to release the iStent

Fill the anterior chamber with a viscoelastic

7

release the button and gently Tap the side of the snorkel to ensure that the device is properly seated

Introduce the inserter through the phaco incision and advance past the pupillary margin

8

Remove the inserter and then the viscoelastic

THE iStent Surgical Procedure

iStent is inserted ab interno through the phaco incision and can be performed under topical anesthesia.

1 2 3 4 5

View the angle under high magnification with a gonioprism

Approach the upper third of the trabecular meshwork at an angle of 15°

Engage the trabecular meshwork and gently advance the iStent into Schlemm’s canal

The iStent is contraindicated in patients with angle-closure glaucoma and other secondary glaucomas such as neovascular glaucoma and uveitic glaucoma. The iStent is also contraindicated in patients with retrobulbar tumor, chronic inflammatory disease, thyroid eye disease, Sturge-Weber syndrome, or any other type of condition where the trabecular meshwork, Schlemm’s canal, or collector channels at the implant site are compromised.

The surgeon should monitor the patient postoperatively for proper maintenance of IOP. If IOP is not adequately maintained after surgery, the surgeon should consider an appropriate medication or other treatment regimen to achieve target IOP.

reduce IOP and medication use with iStent

®

73% 67%

of patients who received iStent remained medication free while sustaining target IOPs of ≤21 mm hg versus only 50% of those who underwent cataract surgery alone 3 ( P