Published in Glaucoma

Foundations for iDose TR: A Procedural Pharmaceutical Approach to Glaucoma

Arkadiy Yadgarov, MD

Arkadiy Yadgarov, MD

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Watch a narrated step-by-step surgical video of iDose TR implantation and review pearls for adopting this procedural pharmaceutical approach to glaucoma care.

Consistent IOP control is essential for managing glaucoma. Although glaucoma eye drops can maintain a target pressure level, many patients struggle to comply with their regimen due to uncomfortable side effects, difficulty with instillation, and the cumulative burden of long-term drop therapy.1-3
Sustained-release procedural pharmaceuticals address these challenges and help maintain consistent pressure control by providing continuous medication independent of patient adherence.4 iDose TR (Glaukos) delivers preservative-free travoprost for up to 3 years with demonstrated safety and tolerability in pivotal clinical trials.3,5,6
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The iDose TR implant consists of a small reservoir containing a highly concentrated travoprost formulation and a nanoporous ethylene-vinyl acetate membrane engineered to control drug elution.4,7
Once implanted, the implant is anchored within the sclera, positioned parallel to the iris and away from the corneal endothelium, to provide steady and consistent IOP-lowering without reliance on patient adherence.

Patient selection considerations

iDose TR is indicated for patients with open-angle glaucoma or ocular hypertension. The procedural intervention may be used across a broad spectrum of disease severity.
Appropriate candidates often include those who are:1,2,7-11
iDose TR combines consistent, long-term drug delivery with a straightforward implantation technique, aligning with an increasingly interventional approach to glaucoma care. The procedure addresses both IOP control and the real-world limitations of chronic topical therapy.

Steps to implanting the iDose TR

The procedural technique, outlined here, may be performed as a standalone intervention or combined with cataract surgery.
  • Step 1: Use a ≥1.5mm incision. Enter incision with iDose TR using a gentle side-to-side motion.
  • Step 2: Anchor the iDose TR through the center of the trabecular meshwork, canal, and into the sclera. Compress all tissues until you see striae.
  • Step 3: Bring the iDose TR back to neutral position prior to release. Slowly pull back and hold the implant release button, then gently pull away from the iDose TR.
  • Step 4: Gently tap either side of the iDose TR to ensure it's properly seated into the sclera.

Pearls for iDose TR implantation success

  • Increase magnification significantly and visualize the injector tip prior to entry.
  • Gonioscopic visualization is essential for clearly identifying the trabecular meshwork and accurately placing and anchoring the implant.
  • Seeing striae and maintaining adequate tissue compression during implantation helps confirm proper depth and fixation.
  • Slow and deliberate release of the implant improves placement precision.
  • Finally, confirming stability with gentle taps after deployment provides reassurance that iDose TR is securely seated.

In conclusion

Appropriate patient selection and meticulous gonioscopic technique are central to achieving optimal outcomes with iDose TR. Attention to tissue compression, implant depth, and controlled release helps ensure stable scleral fixation and proper positioning away from the corneal endothelium.
As glaucoma care continues to evolve toward more interventional strategies, iDose TR offers a procedural approach that addresses both disease management and the limitations of chronic topical treatment.

Financial disclosure: Dr. Yadgarov was compensated by Glaukos for the contribution of the surgical video.

  1. Nordstrom BL, Friedman DS, Mozaffari E, Quigley HA, Walker AM. Persistence and adherence with topical glaucoma therapy. Am J Ophthalmol. 2005;140(4):598-606.
  2. Kucukevcilioglu M, Bayer A, Uysal Y, Altinosy HI. Prostaglandin associated periorbitopathy in patients using bimtoprost, latanoprost and travoprost. Clin Exp Ophthalmol. 2014;42(2):126-131.
  3. Medeiros FA, Walters TR, Kolko M, et al; ARTEMIS 1 Study Group. Phase 3, randomized, 20-month study of bimatoprost implant in open-angle glaucoma and ocular hypertension (ARTEMIS 1). Ophthalmology. 2020;127(12):1627-1641.
  4. Belamkar A, Harris A, Zukerman R, et al. Sustained release glaucoma therapies: novel modalities for overcoming key treatment barriers associated with topical medications. Ann Med. 2022;54(1):343-358.
  5. Bacharach J, Tatham A, Ferguson G, et al; ARTEMIS 2 Study Group. Phase 3, randomized, 20-month study of the efficacy and safety of bimatoprost implant in patients with open-angle glaucoma and ocular hypertension (ARTEMIS 2). Drugs. 2021;81(17):2017-2033.
  6. Weinreb RN, Christie WC, Mederios FA, et al. Single administration of bimatoprost implant: effects on 24-hour intraocular pressure and 1-year outcomes. Ophthalmol Glaucoma. 2023;6(6):599-608.
  7. Glaukos Corporation. iDose TR (travoprost intracameral implant) 75 mcg Prescribing Information. 2023.
  8. Travatan Z. Prescribing information. Novartis Pharmaceuticals Corporation.
  9. Mylla Boso AL, Gasperi E, Fernandes L, Costa VP, Alves M. Impact of ocular surface disease treatment in patients with glaucoma. Clin Ophthalmol. 2020;14:103-111.
  10. Sarkisian SR Jr, Ang RE, Lee AM, et al. Phase 3 randomized clinical trial of the safety and efficacy of travoprost intraocular implant in patients with open-angle glaucoma or hypertension. Ophthalmology. 2024;131(9):1021-1032.
  11. Sarkisian SR, Ang RE, Lee AM, et al. Travoprost intracameral implant for open-angle glaucoma or ocular hypertension: 12-month results of a randomized, double-masked trial. Ophthalmol Ther. 2024;13(4):995-1014.
Arkadiy Yadgarov, MD
About Arkadiy Yadgarov, MD

Dr. Arkadiy Yadgarov is a Board Certified Ophthalmologist who graduated summa cum laude from Georgia Tech, and received his MD degree from The Medical College of Georgia in Augusta. His ophthalmology residency at the Institute of Ophthalmology and Visual Science of Rutgers University in New Jersey exposed him to a wide spectrum of complex eye diseases, challenging eye surgeries, and ocular trauma. He graduated with nationally ranked academic scores at the top of his class, and was honored with the Alfonse A. Cinotti, M.D. Award for Academic and Professional Excellence.

Dr. Yadgarov then completed his glaucoma fellowship at the prestigious New York Eye and Ear Infirmary. His surgical experience includes Baerveldt, Ahmed, and Molteno tube shunt implants, Xen Gel stent, trabeculectomy surgery, Kahook goniotomy, I-Stent insertion, and diode cyclophotocoagulation. He also has a special interest in advanced cataract surgery, including the use of iStent devices. He is a member of the American Academy of Ophthalmology and the American Glaucoma Society. Dr. Yadgarov was raised in the North Druid Hills area and is excited to be practicing back in his hometown of Atlanta.

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