Sustained Intraocular Pressure Control After iStent Infinite® Implantation for Steroid-Induced Glaucoma: A Case Report

TL;DR

A patient with steroid-induced glaucoma had stable eye pressure after receiving three iStent devices, avoiding the need for ongoing drops.

Contribution

First reported case of successful iStent infinite implantation for steroid-induced glaucoma.

Findings

IOP decreased from 34 mmHg to 13 mmHg post-surgery and remained stable for 12 months.

Triple iStent infinite implantation provided sustained IOP control without spikes during continued steroid use.

Abstract

Background/Objectives: Steroid-induced glaucoma (SIG) or ocular hypertension is a well-known complication after corticosteroid exposure to the eye, particularly intravitreal dexamethasone implantation. The main mechanism of elevated intraocular pressure (IOP) is trabecular meshwork dysfunction, leading to increased aqueous outflow resistance. Although most SIG cases respond to medical treatment, some patients develop persistent IOP elevation, requiring surgical intervention. Minimally invasive glaucoma surgery (MIGS) has recently emerged as a safer surgical option, but there are a limited number of reports using MIGS for SIG. Methods: A 73-year-old man, who had branch retinal vein occlusion with refractory macular edema despite multiple anti-VEGF injections, received an intravitreal Ozurdex® (Allergan, Irvine, CA, USA) implant. He developed marked IOP elevation from 17 to 34 mmHg despite maximal topical therapy. Visual field progression and progressive retinal nerve fiber layer thinning were also observed. Given the need for continued ocular steroid use and only having one arm due to trauma making drops difficult, three trabecular micro-bypass stent devices (iStent infinite®, Glaukos Corp., Aliso Viejo, CA, USA) were implanted for IOP control. Postoperatively, IOP decreased to 13 mmHg and remained stable at 15 mmHg for 12 months. Additionally, macular edema was well-controlled with ongoing Ozurdex treatment and no observed IOP spikes. Conclusions: This is the first reported case of SIG-associated Ozurdex successfully managed with triple trabecular micro-bypass stents. The iStent infinite implantation provided safe and sustained IOP control for SIG, highlighting its potential role in patients requiring continuous intravitreal steroids.

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