Clinical Scorecard: Combining MIGS With Implant Lowers IOP in Glaucoma

At a Glance

Key Highlights

• Significant IOP reduction observed with iStent Infinite and cataract surgery (mean 1.9 mmHg decrease)
• Addition of iDose TR implant further increased IOP reduction (mean 2.6 mmHg decrease) and medication-free status
• No treatment-related adverse events reported in either group

Guideline-Based Recommendations

Diagnosis

• Identify patients with open-angle glaucoma suitable for combined MIGS and cataract surgery

Management

• Consider iStent Infinite implantation with cataract surgery to lower IOP and reduce topical medication burden
• Add iDose TR intracameral implant to enhance IOP reduction and increase likelihood of medication-free status

Monitoring & Follow-up

• Track intraocular pressure pre- and post-operatively over 3 to 6 months
• Monitor for need of additional glaucoma surgery if IOP control is inadequate

Risks

• Low incidence of adverse events reported; monitor for potential need for trabeculectomy in refractory cases

Patient & Prescribing Data

49 patients with moderate open-angle glaucoma undergoing cataract surgery

Combining iStent Infinite with cataract surgery reduces IOP and topical medication use; adding iDose TR further improves outcomes with higher rates of IOP <10 mmHg and medication-free eyes

Clinical Best Practices

• Use combined MIGS and cataract surgery as a proactive approach to improve glaucoma management and patient quality of life
• Tailor treatment by adding sustained-release travoprost implant (iDose TR) to maximize IOP reduction and reduce medication burden
• Ensure close follow-up to identify patients requiring further surgical intervention

References

• 2026 ASCRS Annual Meeting Presentation by Dr. Lisa Feulner
• Ophthalmology Management