Meta-Analysis of MINIject vs. Two iStents as Standalone Treatment for Glaucoma with 24 Months of Follow-Up.

This study compares the long-term intraocular pressure (IOP)-lowering efficacy of standalone MINIject (iSTAR Medical, Belgium) suprachoroidal implantation and two iStent (Glaukos, CA, USA) trabecular bypass implantation using a systematic review and meta-analysis. Systematic review of standalone implantation of MINIject or iStent inject with at least 24 months of follow up. The mean and standard deviation of IOP and the number of IOP-lowering medications at baseline and at 24 months were extracted. Weighted estimates of the outcome variables were calculated using random-effects meta-analysis models. Heterogeneity in the outcome measures among the studies was quantified using I². : Seven studies (three studies for MINIject and four for iStent) comprising 280 eyes were included. At 24 months, there was a greater reduction in IOP from baseline in the MINIject vs. two iStent cohorts (-9.57 vs. -4.92 mmHg, = 0.03). The change from baseline in mean medication use was -1.00 with MINIject and -0.56 medications with iStent ( = 0.26). The mean percentage IOP reduction at 24 months ranged from 36.3-42.2% with MINIject compared to 5.2-40.7% with iStent, with greater variability in mean change from baseline in IOP observed in the iStent group (I = 96.5% vs. 0%). The most frequent adverse events for MINIject were anterior chamber inflammation, best-corrected visual acuity (BCVA) loss, hyphema, and conjunctival hemorrhage, and for iStent, these were device obstruction, BCVA loss, IOP spike, and cataract progression. While both MINIject and iStent inject devices resulted in significant reductions in IOP and IOP medication use, standalone MINIject may provide a greater and more consistent reduction in IOP.