Early Real-World Safety and Short-Term Outcomes of Combined iStent Infinite and Intracameral Travoprost Implant (iDose TR) with or without Cataract Surgery

Purpose: To evaluate early real-world safety and short-term outcomes of combined trabecular bypass and intracameral travoprost implantation with or without cataract surgery in patients treated to optimize intraocular pressure control and/or reduce topical medication burden. Methods: This retrospective case series included eyes with open-angle glaucoma undergoing combined trabecular bypass and intracameral travoprost implantation with or without cataract surgery at a single center, with a minimum of three months of follow-up. The primary endpoint was a composite of ≥ 1 medication reduction without clinically meaningful intraocular pressure (IOP) worsening (increase < 2 mmHg) or ≥ 20% IOP reduction with stable medication use at postoperative month three. Secondary endpoints included changes in IOP, medication burden, and safety. Baseline and postoperative outcomes were compared using generalized estimating equation models to account for inter-eye correlation, with exploratory subgroup analyses using independent t-tests and Fisher’s exact tests. Results: Thirty-three eyes from 24 patients were included, including 18 standalone procedures and 15 combined with cataract surgery. At postoperative month three (POM3), the composite primary endpoint was achieved in 26 of 33 eyes (78.8%). Mean intraocular pressure decreased from 19.64± 7.32 mmHg to 14.97± 4.62 mmHg (mean reduction 4.67 mmHg; p < 0.001), and mean topical medication burden decreased from 1.97± 1.05 to 0.82± 0.92 medications ( p < 0.001). No intraoperative complications, postoperative adverse events, layered hyphema, intraocular pressure spikes, device malposition, or return to the operating room occurred. Conclusion: Combined trabecular bypass and sustained intracameral prostaglandin delivery demonstrated favorable early safety and clinically meaningful short-term control of both medication burden and IOP in a real-world cohort. Longer-term follow-up is warranted to assess durability. Plain Language Summary: Glaucoma can cause vision loss if eye pressure is not controlled. Many patients use daily eye drops, but some have difficulty using them or develop side effects. In this study, patients received two treatments together: a small drainage implant (iStent Infinite) and a long-acting medication implant (iDose TR), with or without cataract surgery. We reviewed 33 eyes and followed patients for about three months. Most eyes had lower eye pressure and needed fewer or no eye drops after surgery. No serious complications were observed. These early results suggest this combined approach may help reduce dependence on daily glaucoma medications, but longer follow-up is needed. Keywords: glaucoma, minimally invasive glaucoma surgery, iStent infinite, intracameral implant, medication adherence, cataract surgery