iStent Infinite™: The Next‑Generation MIGS Stent That Lets Glaucoma Patients Breathe Easier

Key Learning Points

1. Glaucoma steals sight silently—regular dilated exams are the only way to catch it early.

2. Lowering intra‑ocular pressure (IOP) is critical; even a 1 mmHg drop cuts the risk of progression by ~10 %.

3. iStent Infinite™ uses three micro‑stents to bypass the eye’s clogged drain—similar to punching three tiny holes in a blocked sink.

4. The device earned FDA clearance in August 2022 for eyes that failed previous medical or surgical therapy.

5. Clinical trials show a 23–30 % average IOP reduction with fewer drops and no serious sight‑threatening events.

6. Surgery takes about 10 minutes, is suture‑less, and can be combined with cataract removal.

7. Most patients return to work in 24–48 hours with only mild temporary redness.

8. Good candidates include adults with primary open‑angle glaucoma uncontrolled by drops or earlier operations.

9. Aftercare is simple: antibiotic‑steroid drops for 2 weeks, no eye‑rubbing, and protective shields at night.

10. Healthy habits—no smoking, regular exercise, and compliance with follow‑ups—keep the stent working for years.

Introduction: Why Talk About Glaucoma?

Glaucoma is a group of eye diseases that slowly damage the optic nerve—the cable that sends images to your brain. Left unchecked, it can narrow vision like a tunnel and eventually cause blindness. Because the early stages are painless and symptom‑free, experts call it the “silent sight‑stealer.”

What Causes the Damage?

Think of your eye as a camera filled with a clear “camera fluid” called aqueous humor. In healthy eyes, this fluid drains through a microscopic sieve (the trabecular meshwork). In glaucoma the sieve becomes clogged, eye pressure rises, and the optic nerve frays like an over‑pulled phone cable. Lowering the pressure is the only proven way to protect vision.

Traditional Treatments and Their Limits

Eye‑drop medicines are the first line of defense, but taking drops four times daily for life can feel like watering plants you never see grow. Laser treatments help but may fade over time, and conventional surgeries such as trabeculectomy are effective yet carry higher risks of leaks or infection. That gap—between drops and big surgery—is where minimally‑invasive glaucoma surgery (MIGS) fits in.

Meet the iStent Infinite™

Released by Glaukos and cleared by the U.S. FDA on August 2, 2022, the iStent Infinite™ Trabecular Micro‑Bypass System inserts three L‑shaped titanium stents into Schlemm’s canal—the natural drain around your iris. Each stent is smaller than an eyelash (0.36 mm). Together they form a triple drain, easing fluid out like extra holes in a clogged sink.

How It Works—The Sink Analogy

Imagine your bathroom sink is filling up because the drain is partly blocked. Instead of replacing the whole pipe, a plumber drills three pinholes just above the clog so water can escape freely. The iStent Infinite™ does the same inside the eye, lowering pressure while preserving natural anatomy.

Evidence You Can Trust

A multicenter pivotal trial followed 72 patients whose glaucoma kept progressing despite prior surgery. Twelve months after a stand‑alone iStent Infinite™ procedure, 76 % achieved at least a 20 % pressure drop without additional meds, and serious complications were zero.
A systematic review comparing MIGS implants echoes these findings: iStent devices reduce IOP effectively with fewer adverse events than traditional surgery.
Another 2023 review of 3,476 eyes highlights that MIGS, including iStent, report low rates of hypotony (pressure too low) and serious infection.

Who Is an Ideal Candidate?

• Adults with primary open‑angle glaucoma whose target IOP is not met despite maximal tolerated drops or previous laser/surgical procedures

• Eyes with open angles on gonioscopy (the drainage angle must be visible)

• Patients who desire quicker recovery and fewer activity restrictions than trabeculectomy offers

Not ideal: closed‑angle glaucoma, active eye infection, uncontrolled inflammation, or those unable to position flat for surgery.

Step‑by‑Step: What to Expect at Roque Eye Clinic

Risks & Side‑Effects—Transparency First

While major complications are uncommon, every procedure carries some risk:

• Transient bleeding (1–2 %)—usually self‑resolving

• Temporary pressure spikes (≈5 %)—managed with pills or taps

• Stent malposition (<1 %)—may require repositioning

• No recorded cases of endophthalmitis or vision‑threatening hypotony in pivotal trials

Living With Your iStent—Prevention & Maintenance

1. Follow the drop schedule we prescribe; stopping suddenly is like turning off a sump pump during a storm.

2. Protect your eyes: wear wrap‑around sunglasses in dusty jeepney rides.

3. Stay active, eat leafy greens, and hydrate—a healthy body supports healthy eye fluid dynamics.

4. Quit smoking; nicotine constricts blood vessels feeding the optic nerve.

5. Attend quarterly check‑ups; early tweaks prevent late troubles.

Frequently Asked Questions

Bibliography

1. iStent Infinite Clinical Trial

1. Sarkisian SJ Jr, Grover DS, Gallardo MJ, et al. Effectiveness and safety of iStent Infinite trabecular micro‑bypass for uncontrolled glaucoma. J Glaucoma. 2023;32(1):9‑18. doi:10.1097/IJG.0000000000002141. PMID: 36260288.

2. U.S. Food & Drug Administration. 510(k) K220032: iStent Infinite Trabecular Micro‑Bypass System. Silver Spring, MD; 2022.

2. Comparative MIGS Evidence

1. Hu R, Guo D, Hong N, et al. Hydrus versus iStent implants with phacoemulsification: systematic review and network meta‑analysis. BMJ Open. 2022;12:e051496. doi:10.1136/bmjopen‑2021‑051496. PMID: 35705355.

3. Safety & Complication Reporting

1. Bonnar J, Azuara‑Blanco A. Reporting quality of complications in innovative glaucoma surgery: systematic review. Eye (Lond). 2023;37:1774‑1777. doi:10.1038/s41433‑022‑02268‑z. PMID: 36253459.

4. Glaucoma Education Resources

1. National Eye Institute (NEI). Glaucoma—facts & resources. Updated 2025. Available at: nei.nih.gov.

5. Additional MIGS Overview

1. Glaukos Corporation. iStent Infinite clinical data summary. 2024.

Take‑Home Message

The iStent Infinite™ gives Filipino glaucoma patients a middle‑ground option: big‑surgery power with contact‑lens‑level downtime. By restoring the eye’s natural drainage through three microscopic stents, it controls pressure, cuts drop dependence, and protects vision—so you can keep seeing life’s important moments without the fear of silent sight loss.