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Harano A, Shimada A, Ichioka S, Sugihara K, Tanito M. Fellow-Eye Comparison between Phaco-Tanito Microhook Trabeculotomy and Phaco-iStent Inject W. J Clin Med 2023; 12:7005. [PMID: 38002619 PMCID: PMC10672605 DOI: 10.3390/jcm12227005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
This study aims to compare the surgical efficacy and safety of the Tanito microhook trabeculotomy (TMH-CE) and iStent inject W (Inject-CE) when performed in combination with cataract surgery on the eyes of glaucoma patients. A total of 78 glaucomatous eyes from 39 participants were retrospectively analyzed. Intraocular pressure (IOP), the number of antiglaucoma medications, best-corrected visual acuity (BCVA), anterior chamber flare (ACF), and corneal endothelial cell density (CECD) were all evaluated preoperatively and at multiple postoperative time points. The preoperative IOP was significantly higher in the TMH-CE (19.6 ± 6.7 mmHg) than in the Inject-CE (15.7 ± 3.8 mmHg) (p < 0.0001). At the 12-month follow-up, reductions in IOP and the number of medications were more pronounced in the TMH-CE (6.6 mmHg, 27.6% and -1.1, respectively) group than Inject-CE (2.7 mmHg, 12.4% and -0.7, respectively) (p < 0.0001 and p = 0.0034), while the IOP and medication-number levels were identical between TMH-CE (13.0 ± 3.3 mmHg and 1.3 ± 0.9, respectively) and Inject-CE (12.9 ± 2.6 mmHg and 1.9 ± 0.9, respectively) (p = 0.88 and p > 0.99, respectively). The TMH-CE group exhibited a higher ACF, a higher frequency of layered hyphema, and a greater anterior chamber floating red blood cells score in the early postoperative periods. Despite these differences, the changes in BCVA, ACF, and CECD were equivalent between the two groups in later follow-up periods. TMH-CE provides a more significant IOP reduction and medication-number reduction compared to Inject-CE, while Inject-CE shows quicker BCVA recovery. This study provides valuable insights for ophthalmologists choosing the most suitable surgical approach for glaucoma and cataract patients.
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Affiliation(s)
| | | | | | | | - Masaki Tanito
- Department of Ophthalmology, Shimane University Faculty of Medicine, Izumo 693-8501, Japan; (A.H.); (A.S.); (S.I.); (K.S.)
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Fang Z, Bi S, Brown JD, Chen J, Pan T. Microfluidics in the eye: a review of glaucoma implants from an engineering perspective. LAB ON A CHIP 2023; 23:4736-4772. [PMID: 37847237 DOI: 10.1039/d3lc00407d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
Glaucoma is a progressive optic neuropathy in the eye, which is a leading cause of irreversible blindness worldwide and currently affects over 70 million individuals. Clinically, intraocular pressure (IOP) reduction is the only proven treatment to halt the progression of glaucoma. Microfluidic devices such as glaucoma drainage devices (GDDs) and minimally invasive glaucoma surgery (MIGS) devices are routinely used by ophthalmologists to manage elevated IOP, by creating an artificial pathway for the over-accumulated aqueous humor (AH) in a glaucomatous eye, when the natural pathways are severely blocked. Herein, a detailed modelling and analysis of both the natural microfluidic pathways of the AH in the eye and artificial microfluidic pathways formed additionally by the various glaucoma implants are conducted to provide an insight into the causes of the IOP abnormality and the improvement schemes of current implant designs. The mechanisms of representative glaucoma implants have been critically reviewed from the perspective of microfluidics, and we have categorized the current implants into four groups according to the targeted drainage sites of the AH, namely Schlemm's canal, suprachoroidal space, subconjunctival space, and ocular surface. In addition, we propose to divide the development and evolution of glaucoma implant designs into three technological waves, which include microtube (1st), microvalve (2nd) and microsystem (3rd). With the emerging trends of minimal invasiveness and artificial intelligence in the development of medical implants, we envision that a comprehensive glaucoma treatment microsystem is on the horizon, which is featured with active and wireless control of IOP, real-time continuous monitoring of IOP and aqueous rate, etc. The current review could potentially cast light on the unmatched needs, challenges, and future directions of the microfluidic structural and functional designs of glaucoma implants, which would enable an enhanced safety profile, reduced complications, increased efficacy of lowering IOP and reduced IOP fluctuations, closed-loop and on-demand control of IOP, etc.
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Affiliation(s)
- Zecong Fang
- Bionic Sensing and Intelligence Center (BSIC), Institute of Biomedical and Health Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, 518055, China.
| | - Shuzhen Bi
- Center for Intelligent Medical Equipment and Devices (iMED), University of Science and Technology of China, Suzhou, Jiangsu, 215123, China
| | | | - Junyi Chen
- Department of Ophthalmology and Visual Science, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, 200031, China
- NHC Key Laboratory of Myopia, Chinese Academy of Medical Sciences, and Shanghai Key Laboratory of Visual Impairment and Restoration (Fudan University), Shanghai, 200031, China
| | - Tingrui Pan
- Bionic Sensing and Intelligence Center (BSIC), Institute of Biomedical and Health Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, 518055, China.
- Center for Intelligent Medical Equipment and Devices (iMED), University of Science and Technology of China, Suzhou, Jiangsu, 215123, China
- Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, Anhui, 230026, China
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Asaoka R, Nakakura S, Mochizuki T, Ishida A, Fujino Y, Ishii K, Obana A, Tanito M, Kiuchi Y. Which is More Effective and Safer? Comparison of Propensity Score-Matched Microhook Ab Interno Trabeculotomy and iStent Inject. Ophthalmol Ther 2023; 12:2757-2768. [PMID: 37548906 PMCID: PMC10441850 DOI: 10.1007/s40123-023-00777-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 07/17/2023] [Indexed: 08/08/2023] Open
Abstract
INTRODUCTION The purpose of this study was to compare the surgical outcomes between ab interno trabeculotomy (LOT) and iStent inject W implantation (iStent) both combined with cataract surgery, matching the background factors including age, intraocular pressure (IOP), medication score, central corneal thickness (CCT), and axial length. METHODS A total of 100 eyes from 75/79 patients with primary open-angle glaucoma were included in the LOT/iStent groups. The background factors were matched between the two groups using the propensity score. RESULTS There were no significant differences in age, IOP, medication score, CCT, and axial length, preoperatively. The postoperative medication scores were 1.3 ± 1.2 and 1.2 ± 1.2 in the LOT and iStent groups. The postoperative IOPs were 12.8 ± 2.8 and 13.1 ± 2.4 mmHg in the LOT and iStent groups, respectively. The changes in the medication score were - 0.64 ± 1.4 and - 0.44 ± 1.6 in the LOT and iStent groups, respectively. The changes in the IOP were - 2.1 ± 3.3 and - 1.5 ± 3.0 mmHg in the LOT and iStent groups, respectively. These values were not significantly different between the two groups. The postoperative IOP and changes in the IOP were significantly associated with preoperative IOP and CCT. There was no significant difference in the occurrence of postoperative complications (hyphema, 11.0% and 6.0%, and transient ocular hypertension, 8.0% and 5.0%, in the LOT and iStent groups, respectively). CONCLUSION LOT and iStent have similar surgical outcomes with sufficient safety. Postoperative IOP was significantly associated with preoperative IOP and CCT in both groups.
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Grants
- 19H01114 Ministry of Education, Science, Techonology, Sports and Cultrue of Japan
- 18KK0253 Ministry of Education, Science, Techonology, Sports and Cultrue of Japan
- 20K09784 Ministry of Education, Science, Techonology, Sports and Cultrue of Japan
- 20K18337 Ministry of Education, Science, Techonology, Sports and Cultrue of Japan
- Japan Glaucoma Society
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Affiliation(s)
- Ryo Asaoka
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Naka-Ku, Hamamatsu City, Shizuoka, Japan.
- Seirei Christopher University, Shizuoka, Japan.
| | - Shunsuke Nakakura
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Hyogo, Japan
| | - Tsukasa Mochizuki
- Department of Ophthalmology and Visual Science, Hiroshima University, Hiroshima, Japan
| | - Akiko Ishida
- Department of Ophthalmology, Faculty of Medicine, Shimane University, Shimane, Japan
| | - Yuri Fujino
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Naka-Ku, Hamamatsu City, Shizuoka, Japan
- Department of Ophthalmology, Faculty of Medicine, Shimane University, Shimane, Japan
| | - Kaori Ishii
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Naka-Ku, Hamamatsu City, Shizuoka, Japan
| | - Akira Obana
- Department of Ophthalmology, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Naka-Ku, Hamamatsu City, Shizuoka, Japan
| | - Masaki Tanito
- Department of Ophthalmology, Faculty of Medicine, Shimane University, Shimane, Japan
| | - Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Science, Hiroshima University, Hiroshima, Japan
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Kitamura K, Fukuda Y, Hasebe Y, Matsubara M, Kashiwagi K. Mid-Term Results of Ab Interno Trabeculectomy among Japanese Glaucoma Patients. J Clin Med 2023; 12:2332. [PMID: 36983331 PMCID: PMC10055689 DOI: 10.3390/jcm12062332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/07/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND The evaluation of ab interno trabeculectomy, referred to as trabectome®, among Japanese patients is insufficient. SUBJECTS AND METHODS Japanese patients who underwent trabectome® at the University of Yamanashi Hospital were included. The investigated parameters were intraocular pressure (IOP), best corrected visual acuity, glaucoma medications, visual field, and corneal endothelial cell density. The success rate and its associated factors were investigated. RESULTS A total of 250 eyes from 197 patients were enrolled. The trabectome® significantly reduced IOP and glaucoma medications up to 48 months. Concomitant cataract extraction enhanced the reduction in IOP and glaucoma medications up to 42 months. At 36 months postoperatively, 40.8% satisfied IOP of the same or less than 18 mmHg or more than a 20% IOP reduction with the same or less use of glaucoma medications as preoperatively. Preoperative IOP and combined cataract extraction were significantly associated with the success rate. The trabectome® alone did not show a significant reduction in corneal endothelial cells. Eyes with postoperative transient IOP elevation and removal of anterior chamber hemorrhage were 11.2% and 1.2%, respectively. Twenty-four eyes (9.6%) underwent additional glaucoma surgeries. CONCLUSIONS The trabectome® could be considered an effective and safe surgery. Compared to trabectome® alone, combined cataract surgery was superior in lowering IOP and reducing glaucoma medications.
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Affiliation(s)
| | | | | | | | - Kenji Kashiwagi
- Department of Ophthalmology, Faculty of Medicine, University of Yamanashi, Chuo 409-3898, Japan
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Cantor L, Lindfield D, Ghinelli F, Świder AW, Torelli F, Steeds C, Dickerson Jr JE, Nguyen DQ. Systematic Literature Review of Clinical, Economic, and Humanistic Outcomes Following Minimally Invasive Glaucoma Surgery or Selective Laser Trabeculoplasty for the Treatment of Open-Angle Glaucoma with or Without Cataract Extraction. Clin Ophthalmol 2023; 17:85-101. [PMID: 36636619 PMCID: PMC9831079 DOI: 10.2147/opth.s389406] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/23/2022] [Indexed: 01/07/2023] Open
Abstract
Introduction Selective laser trabeculoplasty (SLT) and minimally invasive glaucoma surgery (MIGS) are increasingly used options for mild-to-moderate open-angle glaucoma (OAG) care. While most MIGS devices are indicated for use in combination with cataract surgery only, with phacoemulsification playing a role in lowering IOP, newer technologies can also be used as standalone glaucoma surgery. Methods This systematic literature review (SLR) aimed to assess the clinical, economic, and humanistic outcomes of MIGS and SLT for the treatment of OAG and was conducted according to PRISMA guidelines. Studies that assessed MIGS or SLT in at least one treatment arm versus any other glaucoma treatment in adults with mild-to-moderate OAG were included. Clinical, humanistic (health-related quality of life [HRQoL] and patient burden), and economic data were extracted, and the methodological quality of included studies was evaluated. Results A total of 2720 articles were screened, and 81 publications were included. Fifty-eight reported clinical outcomes. The majority assessed iStent or iStent inject (n=41), followed by OMNI (n=9), gonioscopy-assisted transluminal trabeculotomy (GATT) or the Kahook Dual Blade (KDB) (n=7), Hydrus (n=6), SLT (n=5), Xen Gel Stent (n=2), PreserFlo (n=1), and iTrack (n=1). IOP reduction was observed across prospective studies, varying from -31% to -13.7% at month 6 and from -39% to -11.4% at year 1 versus baseline. Most adverse events were transient and non-serious. Limited humanistic and economic data were identified. Conclusion Given their established efficacy and safety, there is a rationale for wider use of MIGS in mild-to-moderate OAG. Of the MIGS devices, iStent and OMNI have the largest clinical evidence base supporting their sustained effectiveness.
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Affiliation(s)
- Louis Cantor
- Eugene and Marilyn Glick Eye Institute, Indiana School of Medicine, Indianapolis, IN, USA
| | - Dan Lindfield
- Royal Surrey County Hospital, Guildford, England, UK
| | | | | | - Francesca Torelli
- Valid Insight, Macclesfield, England, UK,Correspondence: Francesca Torelli, Valid Insight, Ropewalks, Newton St, Macclesfield, SK11 6QJ, UK, Tel +44 203 750 9833 Ext 703, Email
| | | | - Jaime E Dickerson Jr
- Sight Sciences, Menlo Park, CA, USA,North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Dan Q Nguyen
- Mid-Cheshire Hospitals NHS Foundation Trust, Crewe, UK
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Fliney GD, Kim E, Sarwana M, Wong S, Tai TYT, Liu J, Sarrafpour S, Chadha N, Teng CC. Kahook Dual Blade versus Trabectome (KVT): Comparing Outcomes in Combination with Cataract Surgery. Clin Ophthalmol 2023; 17:145-154. [PMID: 36647517 PMCID: PMC9840398 DOI: 10.2147/opth.s391527] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
Purpose To compare the safety and efficacy of Kahook Dual Blade (KDB) versus Trabectome with cataract surgery in reducing intraocular pressure (IOP) and medications used by patients with glaucoma. Methods Retrospective chart review comparing eyes after KDB or Trabectome with cataract surgery at 2 academic centers. Surgical success was defined as IOP <21 mmHg with ≥20% IOP reduction at post-operative month 12 (POM12). Changes in IOP, number of glaucoma medications, and adverse events were assessed. Results Ninety eyes in the KDB group and 125 eyes in the Trabectome group were included. Mean changes in IOP at POM12 were -1.9 ± 4.9 mmHg (11.2%, P = 0.002) in the KDB group and -3.5 ± 5.5 mmHg (19.1%, P < 0.001) in the Trabectome group, without a significant difference between the groups (P = 0.20). Mean change in glaucoma medications at POM12 was -0.8 ± 1.5 in the KDB group (58%, P < 0.001) and -0.3 ± 1.3 (38%, P = 0.003) in the Trabectome group, with KDB having a greater decrease in medications (P = 0.02). The percentage of eyes achieving success was 30% for the KDB group and 54% for the Trabectome group (P = 0.01). Hyphema was the most common complication, with an incidence of 3% for the KDB group and 14% for the Trabectome group (P = 0.01). Conclusion KDB or Trabectome with cataract surgery is safe and effective at lowering IOP and medication burden, with KDB resulting in a greater reduction in medications and Trabectome more frequently achieving success with an increased incidence of hyphema. Considering the study's limitations, the outcomes were similar.
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Affiliation(s)
- Greg D Fliney
- Yale University School of Medicine, Department of Ophthalmology and Visual Science, New Haven, CT, USA
| | - Eliott Kim
- Icahn School of Medicine at Mount Sinai/New York Eye and Ear, Eye and Vision Research Institute, New York, NY, USA
| | | | - Sze Wong
- Icahn School of Medicine at Mount Sinai/New York Eye and Ear, Eye and Vision Research Institute, New York, NY, USA
| | - Tak Yee Tania Tai
- Icahn School of Medicine at Mount Sinai/New York Eye and Ear, Eye and Vision Research Institute, New York, NY, USA
| | - Ji Liu
- Yale University School of Medicine, Department of Ophthalmology and Visual Science, New Haven, CT, USA
| | - Soshian Sarrafpour
- Yale University School of Medicine, Department of Ophthalmology and Visual Science, New Haven, CT, USA
| | - Nisha Chadha
- Icahn School of Medicine at Mount Sinai/New York Eye and Ear, Eye and Vision Research Institute, New York, NY, USA
| | - Christopher C Teng
- Yale University School of Medicine, Department of Ophthalmology and Visual Science, New Haven, CT, USA
- Correspondence: Christopher C Teng, Yale University School of Medicine, Department of Ophthalmology and Visual Science, 40 Temple Street Suite 3D, New Haven, CT, 06510, USA, Tel +1 203-785-2020, Fax +1 203-7856220, Email
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7
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Holmes DP, Clement CI, Nguyen V, Healey PR, Lim R, White A, Yuen J, Lawlor M. Comparative study of 2-year outcomes for Hydrus or iStent inject microinvasive glaucoma surgery implants with cataract surgery. Clin Exp Ophthalmol 2022; 50:303-311. [PMID: 35077009 DOI: 10.1111/ceo.14048] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/29/2021] [Accepted: 12/27/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND To compare real-world 24-month outcomes of phacoemulsification combined with either iStent inject or Hydrus Microstent. METHODS Analysis of data from the Fight Glaucoma Blindness (FGB) international registry. Anonymized data from 344 eyes with mild-to-moderate open-angle glaucoma, normal-tension glaucoma or ocular hypertension that underwent phacoemulsification combined with either iStent inject (224) or Hydrus Microstent (120) were included. Data were adjusted for baseline characteristics using linear regression and propensity score matching. The primary endpoint was a comparison of mean intraocular pressure (IOP) at 24 months. RESULTS At 24 months, there was no significant difference in IOP reduction between the two groups, consistent across all analyses. The matched cohort showed iStent inject achieved 3.1 mmHg reduction and Hydrus a 2.3 mmHg reduction (p = 0.530) and a mean medication reduction of 1.0 for iStent inject versus 0.5 for Hydrus (p = 0.081). 5.4% of eyes in the iStent inject group and 7.5% of eyes in the Hydrus group required subsequent procedures to improve IOP control within 24 months. Complications were rare with no significant differences between the groups. CONCLUSIONS Twenty-four-month outcomes showed sustained IOP reduction with a good safety profile for both groups. There was no significant difference in IOP outcomes between the groups. There may be a small additional reduction in glaucoma medication usage following cataract surgery with iStent inject compared to Hydrus.
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Affiliation(s)
- David P Holmes
- Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Colin I Clement
- Save Sight Institute, Faculty of Medicine and Health, University of Sydney, Australia.,Department of Ophthalmology, Sydney Eye Hospital, Sydney, New South Wales, Australia.,Department of Ophthalmology, Eye Associates, Sydney, New South Wales, Australia
| | - Vuong Nguyen
- Save Sight Institute, Faculty of Medicine and Health, University of Sydney, Australia
| | - Paul R Healey
- Save Sight Institute, Faculty of Medicine and Health, University of Sydney, Australia.,Department of Ophthalmology, Sydney Eye Hospital, Sydney, New South Wales, Australia.,Department of Ophthalmology, Eye Associates, Sydney, New South Wales, Australia.,Westmead Hospital, Cnr Hawkesbury Road and, Westmead, New South Wales, Australia.,Department of Ophthalmology, University of Sydney, Camperdown, New South Wales, Australia
| | - Ridia Lim
- Save Sight Institute, Faculty of Medicine and Health, University of Sydney, Australia.,Department of Ophthalmology, Sydney Eye Hospital, Sydney, New South Wales, Australia
| | - Andrew White
- Westmead Hospital, Cnr Hawkesbury Road and, Westmead, New South Wales, Australia.,Department of Ophthalmology, University of Sydney, Camperdown, New South Wales, Australia
| | - Joshua Yuen
- Department of Ophthalmology, Applecross Eye Clinic, Ardross, Western Australia, Australia
| | - Mitchell Lawlor
- Save Sight Institute, Faculty of Medicine and Health, University of Sydney, Australia.,Department of Ophthalmology, Sydney Eye Hospital, Sydney, New South Wales, Australia
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8
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Role of minimally invasive glaucoma surgery in the management of chronic open-angle glaucoma. Sci Rep 2021; 11:21432. [PMID: 34728652 PMCID: PMC8563755 DOI: 10.1038/s41598-021-00808-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 10/18/2021] [Indexed: 11/09/2022] Open
Abstract
To compare the safety and efficacy of phacoemulsification combined with ab-interno trabeculectomy (Trabectome) and phacoemulsification combined with I-Stent inject in patients with medically uncontrolled primary open-angle glaucoma (POAG). A retrospective comparative case series. 70 eyes of 66 patients completed 2 years follow up after these treatments performed in 2017–2018. 35 eyes of 33 patients underwent combined Phaco-Trabectome (PT); and 35 eyes of 33 patients underwent combined Phaco-I-Stent inject (Pi). Patient demographics and preoperative characteristics are comparable. A 20% drop in IOP was achieved in 27 eyes (77.14%) in PT group and 28 eyes (80%) in Pi group (p = 0.77). Success rate (target IOP achieved and maintained for 2 years) in advance glaucoma was 25% in PT group and 30.7% in Pi group (p = 0.90). In mild to moderate glaucoma, success rate was 85.71% in PT group and 90% in Pi group (p = 0.67). There was no significant difference between two groups with regards to mean reduction in glaucoma medications and complication rates. Trabectome and I-Stent combined with phacoemulsification are equally efficacious and safe for treating patients with medically uncontrolled mild and moderate primary open-angle glaucoma (POAG). However, they are not an effective treatment for patients with advanced glaucoma.
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9
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Three-Year Outcomes of Second-generation Trabecular Micro-bypass Stents (iStent inject) With Phacoemulsification in Various Glaucoma Subtypes and Severities. J Glaucoma 2021; 30:266-275. [PMID: 33105306 DOI: 10.1097/ijg.0000000000001716] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/04/2020] [Indexed: 12/21/2022]
Abstract
PRECIS This longitudinal case series provides valuable long-term data on the safety and efficacy of iStent inject with concomitant cataract surgery. Patients experienced significant and durable reductions in both intraocular pressure (IOP) and medication burden through 3 years postoperative. PURPOSE The purpose of this study was to examine the 3-year effectiveness and safety of iStent inject second-generation trabecular micro-bypass stent implantation with concomitant phacoemulsification cataract surgery in eyes with various glaucoma subtypes and severities. METHODS This was a single-center consecutive case series. Three-year outcomes included mean IOP and medications, the proportions of eyes with IOP ≤18, ≤15, and ≤12 mm Hg, and success (absence of secondary glaucoma interventions). Safety included best-corrected visual acuity (BCVA), cup-to-disc ratio, visual field (VF) mean deviation, retinal nerve fiber layer (RNFL), and ganglion cell-inner plexiform layer (GCIPL) thickness, and adverse events. RESULTS A total of 124 eyes with different glaucoma subtypes and severities were included. At 3 years postoperative, mean IOP reduced from 16.90±3.85 mm Hg preoperatively to 13.17±2.83 mm Hg (22% reduction, P<0.001) and mean medication burden decreased from 2.38±1.29 medications preoperatively to 1.16±1.22 medications (51% reduction, P<0.001). At 3 years, 96% of eyes achieved IOP ≤18 mm Hg (vs. 69% preoperatively), 80% of eyes achieved IOP ≤15 mm Hg (vs. 40% preoperatively), and 42% of eyes achieved IOP ≤12 mm Hg (vs. 7% preoperatively) with 76% of eyes eliminating ≥1 medication and 37% of eyes eliminating ≥2 medications versus preoperative medication burden. The 3-year cumulative survival rate was 74%. Postphacoemulsification BCVA improvement was preserved, and cup-to-disc ratio, VF mean deviation, and RNFL and GCIPL thickness remained stable. A favorable safety profile included no intraoperative complications and few, transient, postoperative adverse events. CONCLUSION Significant and sustained IOP and medication reductions were achieved through 3 years after iStent inject implantation with cataract surgery in a real-world clinical population with mild-to-severe glaucoma, along with favorable safety including stable BCVA, VF, and RNFL and GCIPL thickness.
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10
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Shalaby WS, Lam SS, Arbabi A, Myers JS, Moster MR, Kolomeyer NN, Razeghinejad R, Shukla AG, Hussein TR, Eid TM, Shalaby SM, Lee D. iStent versus iStent inject implantation combined with phacoemulsification in open angle glaucoma. Indian J Ophthalmol 2021; 69:2488-2495. [PMID: 34427250 PMCID: PMC8544096 DOI: 10.4103/ijo.ijo_308_21] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Purpose To compare the outcomes of iStent vs. iStent inject implantation combined with phacoemulsification. Methods This single center retrospective comparative case series included subjects with open angle glaucoma who underwent iStent or iStent inject implantation combined with phacoemulsification with ≥1 year follow-up. The main outcome measures were in-group and between-group changes in intraocular pressure (IOP) and medication number, proportion of eyes that achieved IOP ≤15 mmHg, and surgical success defined as 20% IOP reduction from baseline at 6/12 months. Univariate/multivariate regression analyses were done to identify predictors of surgical failure. Results One hundred ninety-seven eyes of 148 patients were included (122 iStent, 75 iStent inject). Both groups achieved significant IOP and medication reduction at months 6/12 (P < 0.05). At month 6, IOP was significantly lower in iStent inject vs. iStent eyes (P = 0.003), but the difference was insignificant by month 12 (P = 0.172). Medication number was comparable in both groups at months 6/12 (P > 0.05). More iStent inject eyes achieved IOP ≤15 mmHg at month 6 (P = 0.003) and 12 (P = 0.047). Surgical success was comparable in both groups at months 6/12 (P > 0.05). Kaplan-Meier survival analysis showed similar cumulative rate of surgical failure at year-1 in both groups (P = 0.644). The multivariate model identified older age (P = 0.017) and lower baseline IOP (P = 0.002) as the strongest predictors of surgical failure. Conclusion Compared to iStent, iStent inject achieved lower IOP at month 6 and higher proportion of eyes achieved IOP ≤15 mmHg at month 6/12. However, surgical success was similar in both groups. Predictors of surgical failure were older age and lower baseline IOP rather than the stent type.
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Affiliation(s)
- Wesam Shamseldin Shalaby
- Glaucoma Research Center, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA; Tanta Medical School, Tanta University, Tanta, Gharbia, Egypt
| | - Sophia S Lam
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Amirmohsen Arbabi
- Glaucoma Research Center, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Jonathan S Myers
- Glaucoma Research Center, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Marlene R Moster
- Glaucoma Research Center, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Natasha N Kolomeyer
- Glaucoma Research Center, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Reza Razeghinejad
- Glaucoma Research Center, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Aakriti Garg Shukla
- Glaucoma Research Center, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Tarek R Hussein
- Tanta Medical School, Tanta University, Tanta, Gharbia, Egypt
| | - Tarek M Eid
- Tanta Medical School, Tanta University, Tanta, Gharbia, Egypt
| | - Said M Shalaby
- Tanta Medical School, Tanta University, Tanta, Gharbia, Egypt
| | - Daniel Lee
- Glaucoma Research Center, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA
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11
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iStent inject: comprehensive review. J Cataract Refract Surg 2021; 47:385-399. [PMID: 32842078 DOI: 10.1097/j.jcrs.0000000000000325] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/22/2020] [Indexed: 11/26/2022]
Abstract
Microinvasive glaucoma surgeries (MIGSs) are new surgical procedures for treatment of glaucoma. They aim to safely and effectively reduce intraocular pressure (IOP) with minimal trauma to the eye and less complications. The first-generation iStent is the first approved ab interno MIGS implant for management of open-angle glaucoma. It works by allowing aqueous humor to drain directly from the anterior chamber into Schlemm canal bypassing the trabecular meshwork, the major site of outflow resistance. The second-generation iStent inject is the smallest available trabecular device that occupies less than 0.5 mm. It is designed to facilitate the surgical technique and allow simultaneous implantation of 2 stents, aiming for more IOP reduction. This review examines publications about the iStent inject, focusing on the device's efficacy, safety, and comparison with the first generation iStent. Both devices were found to be a safe and effective tool in management of open-angle glaucoma.
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Abstract
Micro- or minimally invasive glaucoma surgeries (MIGS) have been the latest addition to the glaucoma surgical treatment paradigm. This term refers not to a single surgery, but rather to a group of distinct procedures and devices that aim to decrease intraocular pressure. Broadly, MIGS can be categorized into surgeries that increase the trabecular outflow [Trabectome, iStent (first and second generations), Hydrus microstent, Kahook Dual Blade and gonioscopy-assisted transluminal trabeculotomy], surgeries that increase suprachoroidal outflow (Cypass microstent and iStent Supra), and conjunctival bleb-forming procedures (Xen gel stent and InnFocus microshunt). Compared to traditional glaucoma surgeries, such as trabeculectomy and glaucoma drainage device implantation (Ahmed, Baerveldt, and Molteno valves), MIGS are touted to have less severe complications and shorter surgical time. MIGS represent an evolving field, and the efficacy and complications of each procedure should be considered independently, giving more importance to high-quality and longer-term studies.
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Affiliation(s)
- David J Mathew
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario M5T 2S8, Canada;
| | - Yvonne M Buys
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario M5T 2S8, Canada;
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Fellow-Eye Comparison between Phaco-Microhook Ab-Interno Trabeculotomy and Phaco-iStent Trabecular Micro-Bypass Stent. J Clin Med 2021; 10:jcm10102129. [PMID: 34069079 PMCID: PMC8157143 DOI: 10.3390/jcm10102129] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 12/15/2022] Open
Abstract
The aim of this study is to compare the surgical efficacy and safety between microhook ab-interno trabeculotomy (µLOT) and iStent trabecular micro-bypass stent implantation when both were combined with cataract surgery in both eyes of patients. Sixty-four glaucomatous eyes (32 participants; mean age, 75.9 ± 7.6 years; 15 men, 17 women) were included retrospectively. Intraocular pressure (IOP), number of antiglaucoma medications, best-corrected visual acuity (BCVA), anterior chamber flare (ACF) and corneal endothelial cell density (CECD) were evaluated preoperatively, as well as 2, 3, 6, and 12 months postoperatively. Surgical complications and interventions were compared between the procedures. The preoperative IOP and medications with µLOT (18.8 ± 5.7 mmHg and 3.0 ± 1.2, respectively) were higher than with the iStent (15.5 ± 3.4 mmHg and 2.7 ± 1.2, respectively) (p = 0.0001 and p = 0.0437, respectively). At 12 months, the µLOT values (12.6 ± 2.3 mmHg and 2.3 ± 0.9, respectively) were identical to iStent (12.8 ± 2.5 mmHg and 2.3 ± 0.9, respectively) (p = 0.0934 and p = 0.3251, respectively). At 12 months, the IOP decreased more with µLOT (6.2 mmHg, 29.5%) than iStent (2.7 mmHg, 15.6%) (p = 0.0003). The decrease in medications was greater with µLOT (0.7) than iStent (0.4) (p = 0.0437). Survival rate of IOP control ≤15 mmHg and IOP reduction ≥20% was significantly higher after µLOT (40.6% at 12 months) than iStent (18.8%) (p = 0.0277). The frequency of layered hyphema was significantly greater with µLOT (8 eyes, 25%) than iStent (0 eyes, 0%) (p = 0.0048). The increase in the ACF at 2 weeks postoperatively was significantly greater with µLOT than iStent (p = 0.0156), while changes in the BCVA and CECD were identical between groups. The fellow-eye comparison showed that the IOP reduction was greater with µLOT than iStent when combined with cataract surgery.
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Steiner S, Resch H, Kiss B, Buda D, Vass C. Needling and open filtering bleb revision after XEN-45 implantation-a retrospective outcome comparison. Graefes Arch Clin Exp Ophthalmol 2021; 259:2761-2770. [PMID: 33977318 PMCID: PMC8380566 DOI: 10.1007/s00417-021-05204-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/26/2021] [Accepted: 04/19/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose To compare efficacy and safety of needling and open bleb revision after XEN-45 surgery. Methods This retrospective study represents real-life data of patients who underwent XEN-45 surgery between November 2014 and June 2018 in the Vienna General Hospital. The following groups were formed for data evaluation: (PSEA) primary surgery secondary intervention allowed (n = 268); (PS) primary surgery until secondary intervention (n = 268); (N) first needling until additional secondary intervention (n = 55); (BR) first bleb revision until additional secondary intervention (n = 105). Main outcome measures were pre- and postoperative intraocular pressure (IOP), number of glaucoma medication (GM), Kaplan–Meier success rates, and secondary intervention rates. Success was defined as postoperative IOP < 21 mmHg and < 18 mmHg together with ≥ 20% IOP reduction with medication allowed. Results IOP (and GM) was lowered from 23.5 ± 8.0 (GM 3.1 ± 1.0) to 14.9 ± 8.2 mmHg (1.2 ± 1.4) in group PSEA and 18.1 ± 8.2 mmHg (1.5 ± 1.4) in group PS, in group N from 23.2 ± 10.1 (1.5 ± 1.0) to 19.3 ± 8.5 mmHg (2.2 ± 1.3) and in group BR from 22.0 ± 8.0 mmHg (2.5 ± 1.1) to 15.5 ± 6.4 mmHg (1.3 ± 1.5) after a median follow-up of 16.0, 8.4, 4.8, and 7.3 months, respectively. Success rates at 1 year were significantly higher in group BR (50.7%) compared to PS (37.7%, p = 0.019) and N (24.3%; p = 0.015). An additional intervention was required less frequently in group BR (17.1%) compared to group PS (49.6%, p < 0.001) and group N (54.5%, p < 0.001). Conclusion Our data appear to indicate favorable outcomes for open XEN bleb revision in terms of Kaplan–Meier success rates and secondary intervention rate compared to the needling procedure.
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Affiliation(s)
- Stefan Steiner
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Hemma Resch
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Barbara Kiss
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Daniel Buda
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Clemens Vass
- Department of Ophthalmology and Optometry, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Pahlitzsch M, Davids AM, Winterhalter S, Zorn M, Reitemeyer E, Klamann MKJ, Torun N, Bertelmann E, Maier AK. Selective Laser Trabeculoplasty Versus MIGS: Forgotten Art or First-Step Procedure in Selected Patients with Open-Angle Glaucoma. Ophthalmol Ther 2021; 10:509-524. [PMID: 33963524 PMCID: PMC8319229 DOI: 10.1007/s40123-021-00347-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 04/24/2021] [Indexed: 01/04/2023] Open
Abstract
Introduction To evaluate the long-term effect on intraocular pressure (IOP) and glaucoma medication of selective laser trabeculoplasty (SLT) compared to minimally invasive glaucoma surgery (MIGS) in primary open-angle glaucoma (POAG) and its potential in clinical practice. Methods A total of 342 consecutive patients (stand-alone procedures) were included. One hundred and five patients underwent SLT treatment (360° SLT, 95–105 spots, Trabeculas SLT ARCLaser, Nürnberg, DE), 107 patients had an ab interno-derived trabeculotomy (Trabectome®, NeoMedix, Tustin, USA), and 130 patients received iStent inject® implantation (2 implants-Glaukos, CA, USA). IOP and glaucoma therapy were evaluated preoperatively, 1 day, 6 weeks, 3 months, 6 months, and 1, 2, and 3 years postoperatively. Statistical analysis was performed using a regression model and propensity matching score (reduced cohort number) using SPSS v20.0. Kaplan–Meier analysis was included using the following six criteria: criterion A (IOP ≤ 21 mmHg with or without medication, qualified success), criterion B (IOP ≤ 18 mmHg with or without medication, qualified success), criterion C (IOP ≤ 21 mmHg without medication, complete success), criterion D (IOP ≤ 18 mmHg without medication, complete success), criterion E (IOP ≤ 21 mmHg and IOP reduction > 20% after therapy), and criterion F (IOP ≤ 18 mmHg and IOP reduction > 20% after therapy). Results In the matched cohort, the SLT cohort showed an IOP reduction of 31.2% from 19.9 ± 2.3 to 13.7 ± 2.7 mmHg (p < 0.001) 3 years postoperatively; in Trabectome® IOP decreased by 31.4% from 20.5 ± 1.3 to 13.8 ± 2.0 mmHg (p < 0.001) and in iStent inject® by 29.9% from 19.5 ± 2.0 to 13.8 ± 2.7 mmHg (p < 0.001). Trabectome® and iStent inject® could not demonstrate a significant reduction in glaucoma therapy (Trabectome®p = 0.138, iStent inject®p = 0.612); a significant drop was noted in SLT (2.2 ± 1.2 to 1.7 ± 1.2, p = 0.046). SLT and MIGS achieved good to moderate survival rates using criterion A (93.3% SLT, 79.7% Trabectome®, 77.6% iStent inject®) and criterion B (74.5% SLT, 48.0% Trabectome®, 56.2% iStent inject®). As expected, low survival rates were obtained with non-filtering procedures: criterion C 11.1% in SLT, 6.5% in Trabectome®, 7.0% in iStent inject® and criterion D 3.0% in SLT, 4.3% in Trabectome®, 3.7% in iStent inject® in 3-year follow-up. Conclusion The SLT is a low-complication and effective method for reducing pressure in mild to moderate POAG. SLT is suitable as an initial procedure when setting up a step scheme; MIGS is the treatment of choice as a follow-up for mild to moderate forms of glaucoma and accepted topical therapy. Ethic approval had been given by the Ethikkommission Charité – Universitätsmedizin Berlin, EA4/047/20—retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1007/s40123-021-00347-0.
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Affiliation(s)
- Milena Pahlitzsch
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Anja-Maria Davids
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Sibylle Winterhalter
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Malte Zorn
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Emanuel Reitemeyer
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Matthias K J Klamann
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Necip Torun
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Eckart Bertelmann
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Anna-Karina Maier
- Department of Ophthalmology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt-Universität Zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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Wagle JA, Flacke JP, Knoerzer D, Ruof J, Merkesdal S. Intraindividual Comparisons to Determine Comparative Effectiveness: Their Relevance for G-BA's Health Technology Assessments. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:744-752. [PMID: 33933244 DOI: 10.1016/j.jval.2020.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 11/06/2020] [Accepted: 11/28/2020] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Health technology assessments (HTA) rely on head-to-head comparisons. We searched for intraindividual comparisons (IIC) qualifying as head-to-head design to develop comparative evidence. METHODS Gemeinsamer Bundesausschuss (G-BA) appraisals between January 2011 and April 2020 were reviewed for inclusion of IIC. Identified IIC were grouped according to disease characteristics into nonprogressive, progressive, irregular, or symmetrical conditions. Evaluation of IIC by Institut für Qualität und Wirschaftlichkeit im Gesundheitswesen (IQWIG) and acceptance of IIC by G-BA were determined, and criteria for the usage and quality of IIC were developed. RESULTS A total of 483 appraisals finalized between January 2011 and April 2020 were reviewed. Eleven appraisals included IIC: nonacog beta (hemophilia B), turoctocog alpha (hemophilia A), emicizumab (2 appraisals: hemophilia A), pasireotide (unresectable pituitary tumor), lomitapid (homozygous familial hypercholesterolemia), glycerol phenylbutyrate (2 appraisals: urea cycle disorders), asfotase alfa (hypophosphatasia), lumacaftor (cystic fibrosis), and larotrectinib (NTRK+ solid tumors). All those appraisals related to rare genetic conditions with hemophilia and its bleeding rate are considered mainly a nonprogressive condition. All the other diseases show progressive disease characteristics. None of the identified IIC has been accepted by G-BA. Inconsistencies of before/after study design, lack of clarity on treatments prior to the switch, and different time intervals were among the most commonly cited methodological concerns. CONCLUSIONS IICs provide a rare opportunity to determine comparative effectiveness in distinct clinical settings that are not suitable or difficult to randomize into parallel groups. While manufacturers and researchers should aim for highest methodological standards when running an IIC, HTA bodies should accept IIC in distinct settings when determining relative effectiveness.
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Affiliation(s)
| | | | | | - Jörg Ruof
- Medical School of Hanover, Hanover, Germany; r-connect ltd.
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Vold SD, Williamson BK, Hirsch L, Aminlari AE, Cho AS, Nelson C, Dickerson JE. Canaloplasty and Trabeculotomy with the OMNI System in Pseudophakic Patients with Open-Angle Glaucoma: The ROMEO Study. ACTA ACUST UNITED AC 2021; 4:173-181. [DOI: 10.1016/j.ogla.2020.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 12/11/2022]
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Standalone iStent Trabecular Micro-bypass Glaucoma Surgery: A Systematic Review and Meta-Analysis. J Glaucoma 2021; 30:606-620. [PMID: 33596009 DOI: 10.1097/ijg.0000000000001805] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 01/07/2021] [Indexed: 11/25/2022]
Abstract
PRECIS Standalone trabecular micro-bypass glaucoma surgery with the iStent devices is associated with clinically relevant reductions in intraocular pressure (IOP) sustained over a reasonably long-term while simultaneously reducing medication burden and a relatively favorable safety profile. PURPOSE While there is a relatively large body of evidence supporting the implantation of the iStent trabecular micro-bypass devices during phacoemulsification in patients with open-angle glaucoma (OAG), its efficacy as a standalone procedure has been less widely reported. The aims of this study were to systematically identify and quantitatively evaluate the efficacy of iStent devices (iStent and iStent inject) when performed independently of cataract surgery in patients with OAG. METHODS A systematic review of the literature was undertaken in August 2019 to identify studies of standalone trabecular micro-bypass glaucoma surgery with iStent devices in patients with OAG. All randomized trials were considered and nonrandomized studies that included at least 6 months of follow-up or more than 10 eyes. Key efficacy analyses included postoperative IOP and medication use, which were used to evaluate weighted mean differences from baseline, and the proportion of eyes free of ocular medication. Postoperative adverse events were descriptively summarized. RESULTS A total of 13 studies were identified including 4 randomized controlled trials and 9 nonrandomized or single-arm studies providing data for 778 eyes. In eyes implanted with iStent devices, a weighted mean IOP reduction of 31.1% was observed at 6 to 12 months. In studies reporting longer-term outcomes (36 to 48 mo or 60 mo), the weighted mean IOP reduction was 30.4% and 32.9%, respectively. The pooled weighted mean reduction in IOP from baseline across all studies at 6 to 12 months and 36 to 60 months poststent implantation was 7.01 mm Hg (95% confidence interval: 5.91, 8.11) and 6.59 mm Hg (95% confidence interval: 5.55, 7.63), respectively. Medication burden was reduced by ~1.0 medication at 6 to 18 months and 1.2 medications at 36 to 60 months. Adverse events reported in more than 5% of participants were progression of pre-existing cataract/cataract surgery and loss of best-corrected visual acuity but these rates were no different to those reported in comparator medical therapy study arms. CONCLUSIONS The results from these studies support the independent effect of the iStent trabecular bypass devices on IOP and medication burden over a duration of follow-up of up to 5 years.
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Arnljots TS, Economou MA. Kahook Dual Blade Goniotomy vs iStent inject: Long-Term Results in Patients with Open-Angle Glaucoma. Clin Ophthalmol 2021; 15:541-550. [PMID: 33603332 PMCID: PMC7884935 DOI: 10.2147/opth.s284687] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/21/2020] [Indexed: 12/05/2022] Open
Abstract
Purpose Efficacy and safety evaluation of Kahook Dual Blade (KDB) goniotomy vs iStent inject implantation. Materials and Methods Retrospective study in patients that underwent goniotomy with KDB or iStent inject implantation, stand-alone or combined with cataract surgery. Main outcome parameters were intraocular pressure (IOP), number of glaucoma medications, proportion of eyes achieving >20% IOP reduction and number of eyes with postoperative IOP <19 mmHg at last follow-up. Results A total of 29 patients (30 eyes) were included in the iStent inject group and 30 patients (32 eyes) in the KDB group. Mean follow-ups were 20.9±6.5 (KDB-alone) to 29.5±7.6 (phaco-iStent inject) months. Pre- and post-operative IOPs were 22.2±5.8 mmHg and 15.9±4.3 mmHg (P=0.004) in the KDB-alone, 24.2±6.8 mmHg and 16.2±6.7 mmHg (P=0.001) in the phaco-KDB, 20.6±5.4 mmHg and 20.9±6.8 mmHg (P=0.598) in the iStent inject-alone as well as 20.9±5.5 mmHg and 15.6±3.4 mmHg (P=0.003) in the phaco-iStent inject subgroups. No major complications occurred. Conclusion All KDB and iStent subgroups except the stand-alone iStent inject subgroup showed a clinically significant IOP-lowering effect as a stand-alone procedure or combined with cataract surgery. Goniotomy with KDB in this setting seems to offer an advantageous IOP reduction compared to iStent inject.
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Affiliation(s)
| | - Mario A Economou
- Division of Ophthalmology and Vision, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Ophthalmology, Sophiahemmet Hospital, Stockholm, Sweden
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Silveira Seixas RC, Balbino M, Basile Neto A, de Alcantara Almeida Costa A, Jordão MLDS, Russ HHA. Mid-Term Evaluation of iStent Inject ® Trabecular Micro-Bypass Stent Implantation with or without Phacoemulsification: A Retrospective Study. Clin Ophthalmol 2020; 14:4403-4413. [PMID: 33364745 PMCID: PMC7751698 DOI: 10.2147/opth.s283587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 11/13/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction This study evaluated the 6-month performance and safety of micro-invasive glaucoma surgery (MIGS) with iStent inject either with or without cataract surgery. Material and Methods Longitudinal retrospective study of 86 surgeries in 49 patients with inadequately controlled open-angle glaucoma (OAG) or ocular hypertension who underwent iStent inject trabecular micro-bypass implantation either alone (isolated group) or combined with cataract surgery (combined group). The two primary outcomes included an intraocular pressure (IOP) drop of ≥20% versus preoperative values (adequate drop) and IOP maintenance between 6 and 18 mmHg (adequate Range). For both outcomes, we determined “complete” and “qualified” success if patients did not require or did require glaucoma medications, respectively, at the end of follow-up. Safety outcomes included best-corrected visual acuity, adverse events, and secondary surgeries. Results In the adequate drop analysis, 30.2% achieved “complete success,” and 37.2% achieved “qualified success.” For adequate range, 40.7% achieved “complete success” and 39.5% achieved “qualified success.” There was no difference in medication decrease (p=0.77) nor IOP reduction (p=0.46) between the isolated and combined groups. Safety was generally favorable and similar between groups, with mild transient adverse events that resulted in no sequelae. Discussion/Conclusion iStent inject implantation either with or without cataract surgery was able to safely decrease IOP and medication requirements through 6 months after surgery.
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Affiliation(s)
| | - Marcos Balbino
- HCloe Oftalmologia Especializada, Centro Universitário São Camilo, São Paulo, SP, Brazil
| | - Alberto Basile Neto
- Clínica Oftalmológica do Complexo Hospitalar Padre Bento de Guarulhos, Guarulhos, SP, Brazil
| | - Amanda de Alcantara Almeida Costa
- Clínica Oftalmológica do Complexo Hospitalar Padre Bento de Guarulhos, Guarulhos, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Marcelo Lopes da Silva Jordão
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto Medical School, Universidade de São Paulo, Ribeirão Preto, Brazil
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Maier AKB, Arani P, Pahlitzsch M, Davids AM, Pilger D, Klamann MKJ, Winterhalter S. Influence of Selective Laser Trabeculoplasty (SLT) on the iStent inject® outcomes. BMC Ophthalmol 2020; 20:457. [PMID: 33213403 PMCID: PMC7678109 DOI: 10.1186/s12886-020-01723-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/09/2020] [Indexed: 11/29/2022] Open
Abstract
Background To evaluate the influence of Selective Laser Trabeculoplasty (SLT) on iStent inject® outcomes in open-angle glaucoma (OAG). Methods In this retrospective comparative cohort outcome study, 66 patients who were treated with two iStent inject® devices were included. Patients were divided into two subgroups consisting of patients without SLT treatment prior to surgery and patients who had been treated previously with 360° SLT but without sufficient response. Outcome measures included intraocular pressure (IOP) and number of antiglaucoma medications after 6 weeks with three, six, 12, and 24 month follow-ups. Results Mean preoperative IOP decreased from 20.4 ± 5.3 mmHg to 14.8 ± 3.0 mmHg for patients without SLT treatment prior to surgery (p = 0.001) and from 19.2 ± 4.5 mmHg to 14.0 ± 1.6 mmHg for patients with insufficient response to 360° SLT treatment (p = 0.027) at 12 months after iStent inject® implantation. No significant difference was found between the two groups (p > 0.05). The number of antiglaucoma medications did not change in both groups (p > 0.05) and showed no significant difference between the two groups (p > 0.05). Conclusion Prior SLT treatment seems to have no negative influence on the IOP lowering-effect of iStent inject® implantation in patients with OAG. It is therefore an appropriate incremental procedure with no exclusion criterion for an iStent inject® implantation.
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Affiliation(s)
- Anna-Karina B Maier
- Department of Ophthalmology, Campus Virchow- Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
| | - Parisa Arani
- Department of Ophthalmology, Campus Virchow- Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Milena Pahlitzsch
- Department of Ophthalmology, Campus Virchow- Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Anja-Maria Davids
- Department of Ophthalmology, Campus Virchow- Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Daniel Pilger
- Department of Ophthalmology, Campus Virchow- Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Matthias K J Klamann
- Department of Ophthalmology, Campus Virchow- Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Sibylle Winterhalter
- Department of Ophthalmology, Campus Virchow- Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt- Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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Hughes T, Traynor M. Clinical Results of Ab Interno Canaloplasty in Patients with Open-Angle Glaucoma. Clin Ophthalmol 2020; 14:3641-3650. [PMID: 33154624 PMCID: PMC7605963 DOI: 10.2147/opth.s275087] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 09/24/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To report treatment outcomes of ab interno canaloplasty using the Visco360 and Omni system devices as a standalone procedure or combined with cataract surgery in patients with open-angle glaucoma (OAG). Design Retrospective, single-center, consecutive case series. Study Patients Eighty-nine eyes of 64 patients aged 43 to 91 with open-angle glaucoma treated with ab interno canaloplasty between January 2018 and September 2019. Eyes with previous incisional glaucoma surgery and eyes with less than 90 degrees of viscodilation were excluded. Intervention Patients underwent ab interno canaloplasty as a stand-alone procedure or in conjunction with cataract surgery. Ab interno canaloplasty was performed with either the Visco360 or Omni System devices (Sight Sciences, Menlo Park, CA). Treatment consisted of viscodilation without trabeculotomy. Main Outcome Measures Primary outcome measures were mean IOP and mean number of glaucoma medications. Additional analysis included the impact of degrees of treatment on treatment outcomes. Results Preoperative mean IOP was 24.5 ± 8.3; the number of preoperative glaucoma medications was 2.5 ± 1.3. At 18 months postoperative, the mean IOP was reduced 36% to 15.8 ± 2.5 (P<0.001) and glaucoma medications were reduced 32% to 1.7 ± 1.5 (P<0.05). Higher preoperative IOP was significantly correlated with increased IOP lowering. Reduction of mean IOP and medications were not significantly different between standalone ab interno canaloplasty vs cataract surgery/ab interno canaloplasty. Reduction of mean IOP and medications were not significantly different between patients with 180 degrees of treatment vs 360 degrees of treatment. Conclusion Ab interno canaloplasty reduces IOP and glaucoma medication use in patients with OAG whether as a standalone surgery or in combination with cataract surgery.
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Costagliola C, Sbordone M, Gandolfi S, Cesari L, Furneri G, Fea AM. Minimally Invasive Surgery in Mild-to-Moderate Glaucoma Patients in Italy: Is It Time to Change? Clin Ophthalmol 2020; 14:2639-2655. [PMID: 32982157 PMCID: PMC7500840 DOI: 10.2147/opth.s264839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/04/2020] [Indexed: 12/11/2022] Open
Abstract
Medical therapy is the first treatment choice for most patients with glaucoma; however, in a relevant proportion of patients, intraocular pressure (IOP) reduction is achieved with multi-therapy and/or high therapeutic doses. Conventional surgery is the standard alternative to medical therapy when this is not effective or not tolerated. Recently, selective laser trabeculoplasty (SLT) has been advocated as first-line therapy, and "minimally invasive glaucoma surgery" (MIGS) has been developed as safer and less traumatic surgical intervention for patients with glaucoma. Schlemm's canal surgery has emerged as one of the approaches with the most favorable risk-benefit profile for glaucoma patients in need of cataract surgery. However, despite the promising results, use of MIGS in Italy has been extremely low. We aimed to investigate the reasons of the lower-than-expected use of Schlemm's canal-based MIGS devices in Italy, share our perspective on their potential place in therapy, and give practical suggestions to improve the management of glaucoma patients.
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Affiliation(s)
- Ciro Costagliola
- Department of Medicine & Health Sciences “V. Tiberio”, University of Molise, Campobasso, Italy
| | - Mario Sbordone
- Ophthalmology Unit, Santa Maria Delle Grazie Hospital, Pozzuoli, Naples, Italy
| | - Stefano Gandolfi
- Ophthalmology Unit, Department of Biological, Biotechnological and Translational Sciences, University of Parma, Parma, Italy
| | - Luca Cesari
- UOC Ophthalmology - Area 5, Ascoli Piceno, San Benedetto del Tronto, Italy
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Esfandiari H, Taubenslag K, Shah P, Goyal S, Weiner AJ, Severson ML, Weiner A, Grover DS, Bussel II, Loewen NA. Two-year data comparison of ab interno trabeculectomy and trabecular bypass stenting using exact matching. J Cataract Refract Surg 2020; 45:608-614. [PMID: 31030775 DOI: 10.1016/j.jcrs.2018.12.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 12/09/2018] [Accepted: 12/10/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE To create a balanced comparison of ab interno trabeculectomy (AIT) (Trabectome) and trabecular bypass stenting (TBS) (iStent). SETTING Eye and Ear Institute, Pittsburgh, Pennsylvania, Ross Eye Institute, Buffalo, New York, and Glaucoma Associates of Texas, Dallas, USA. DESIGN Retrospective case series. METHODS The primary outcome measure was an unmedicated intraocular pressure (IOP) of 21 mm Hg or less and the secondary measure was an unmedicated IOP reduction of 20% or more at 2 years. Patients were matched by baseline IOP, number of glaucoma medications, and glaucoma type using exact matching and by age using nearest neighbor matching. Individuals without a close match were excluded. All surgeries were combined with phacoemulsification. RESULTS One hundred fifty-four AIT eyes and 110 TBS eyes were analyzed. Forty-eight AIT patients were exactly matched with 48 TBS patients. Both groups had a mean baseline IOP of 15.3 mm Hg ± 3.1 (SD). At 24 months, the mean IOP was 13.9 ± 3.3 mm Hg in AIT patients and 16.8 ± 2.8 mm Hg in TBS patients and the mean number of medications was 0.7 ± 1.0 and 1.7 ± 1.2, respectively (both P = .04). At 24 months, the IOP was 21 mm Hg or less without medications in 53% of AIT patients and 16.6% of TBS patients (P < .05). At that time, 17.6% of patients in the AIT group but no patient in the TBS group had an IOP reduction of 20% or more without medication. CONCLUSION An exact matching comparison of AIT and TBS showed greater IOP reduction with fewer medications after AIT.
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Affiliation(s)
- Hamed Esfandiari
- Department of Ophthalmology, School of Medicine, University of Pittsburgh, Pennsylvania, USA
| | - Kenneth Taubenslag
- Department of Ophthalmology, School of Medicine, University of Pittsburgh, Pennsylvania, USA
| | - Priyal Shah
- Department of Ophthalmology, School of Medicine, University of Pittsburgh, Pennsylvania, USA
| | - Swati Goyal
- Eye Q Superspeciality Eye Hospital, Gurgaon, India
| | - Adam J Weiner
- Beaumont Eye Institute, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - Melissa L Severson
- Department of Ophthalmology and Ira G. Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo/State University of New York, USA
| | - Asher Weiner
- Department of Ophthalmology and Ira G. Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo/State University of New York, USA
| | | | - Igor I Bussel
- Department of Ophthalmology, School of Medicine, University of Pittsburgh, Pennsylvania, USA
| | - Nils A Loewen
- Department of Ophthalmology, University of Würzburg, Würzburg, Germany.
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Gillmann K, Mansouri K. Minimally Invasive Glaucoma Surgery: Where Is the Evidence? Asia Pac J Ophthalmol (Phila) 2020; 9:203-214. [PMID: 32501895 PMCID: PMC7299223 DOI: 10.1097/apo.0000000000000294] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 04/04/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The last decade has witnessed an unprecedented growth in glaucoma treatment options through the introduction of minimally invasive glaucoma surgeries (MIGS). The aim of the present review is to provide an understanding of the currently available MIGS and to examine what data are currently available to guide treatment choice. DESIGN Meta-analysis and systematic review of randomized and non-randomized control trials. METHODS Out of 2567 articles identified, a total of 77 articles were retained for analysis, including 28 comparative studies and 12 randomized control trials. Overall, 7570 eyes were included. When data permitted, the weighted mean difference in intraocular pressure reduction was calculated for comparison purposes. RESULTS Weighted mean intraocular pressure reductions from all analyzed studies were: 15.3% (iStent), 29.1% (iStent inject), 36.2% (ab interno canaloplasty), 34.4% (Hydrus), 36.5% (gonioscopically-assisted transluminal trabeculotomy), 24.0% (trabectome), 25.1% (Kahook dual blade), 30.2% (Cypass), 38.8% (XEN), and 50.0% (Preserflo). CONCLUSIONS One of the advantages of the heterogenous range of available MIGS options is the chance to tailor therapy in an individualized manner. However, high-quality data are required to make this choice more than an educated guess. Overall, this review confirms the efficiency of assessed MIGS compared with standalone phacoemulsification, but it highlights that only few studies compare different MIGS techniques and even fewer assess MIGS against criterion standard treatments. Current evidence, while non-negligible, is mostly limited to heterogenous nonrandomized studies and uncontrolled retrospective comparisons, with few quality randomized control trials. We suggest that future research should be comparative and include relevant comparators, standardized to report key outcome features, long-term to assess sustainability and late complications, and ideally randomized.
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Affiliation(s)
- Kevin Gillmann
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland
| | - Kaweh Mansouri
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland
- Department of Ophthalmology, University of Colorado School of Medicine, Denver, CO, USA
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Salimi A, Lapointe J, Harasymowycz P. One-Year Outcomes of Second-Generation Trabecular Micro-Bypass Stents (iStent Inject) Implantation with Cataract Surgery in Different Glaucoma Subtypes and Severities. Ophthalmol Ther 2019; 8:563-575. [PMID: 31538316 PMCID: PMC6858422 DOI: 10.1007/s40123-019-00214-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To assess the 1-year efficacy and safety of the implantation of two second-generation trabecular micro-bypass stents (iStent Inject®) with concomitant cataract surgery in various subtypes and severities of glaucoma. METHODS This single-surgeon, consecutive case series from a Canadian academic ophthalmology center included subjects with cataract, glaucoma, and the need to reduce intraocular pressure (IOP) and/or medications. The 12-month outcomes included mean IOP and medication burden as well as the proportions of eyes with IOP ≤ 18, ≤ 15, and ≤ 12 mmHg compared to baseline. Other measures included corrected distance visual acuity (CDVA), cup-to-disc ratio (CDR), visual field mean deviation (VF MD), retinal nerve fiber layer (RNFL) thickness, ganglion cell inner plexiform layer (GCIPL) thickness, and adverse events. RESULTS In 118 eyes, mean IOP reduced from 17.00 ± 3.82 mmHg preoperatively to 13.97 ± 2.65 mmHg at the 12-month follow-up mark (17.8% reduction, p < 0.001), and mean medication burden decreased from 2.31 ± 1.33 preoperatively to 1.03 ± 1.10 medications (56% reduction, p < 0.001). After 12 months, 93% of eyes achieved IOP ≤ 18 mmHg (versus 69% preoperatively), 70% of eyes achieved IOP ≤ 15 mmHg (versus 42% preoperatively), and 29% of eyes achieved IOP ≤ 12 mmHg (versus 7% preoperatively). For all eyes, topical medications were either maintained or decreased from baseline, with ≥ 1 medication eliminated from the preoperative regimen for 83% of eyes and ≥ 2 medications eliminated for 36% of eyes. Visual acuity improved significantly, consistent with expectations for cataract surgery, while CDR, VF MD, and RNFL and GCIPL thicknesses remained stable. Safety was favorable, with no intraoperative complications and few transient adverse events postoperatively. CONCLUSION iStent Inject implantation with cataract surgery safely reduced IOP and medication burden in a real-world clinical population with mild to severe glaucoma, and stabilized visual field, as well as RNFL and GCIPL thicknesses on OCT. FUNDING The Rapid Service Fees were funded by Glaukos Corporation.
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Affiliation(s)
- Ali Salimi
- Faculty of Medicine, McGill University, Montreal, QC, Canada
- Montreal Glaucoma Institute, Montreal, QC, Canada
| | - Julie Lapointe
- Montreal Glaucoma Institute, Montreal, QC, Canada
- Department of Ophthalmology, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Paul Harasymowycz
- Montreal Glaucoma Institute, Montreal, QC, Canada.
- Department of Ophthalmology, University of Montreal, Montreal, QC, Canada.
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Jozic L, Magner J, Funk J, Töteberg-Harms M. Success of combined cataract extraction plus excimer laser trabeculotomy exceeds that of combined ab interno trabeculectomy with the trabectome or cataract extraction alone. Int Ophthalmol 2019; 40:529-537. [PMID: 31724109 DOI: 10.1007/s10792-019-01191-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 10/10/2019] [Indexed: 01/12/2023]
Abstract
PURPOSE To determine the efficacy of cataract surgery alone and combined with two minimally invasive glaucoma surgery (MIGS) procedures (phaco-ELT and phaco-aiT). METHODS Data was collected from 12/2007 to 02/2012 in this retrospective, non-randomized, comparative single surgery center study. Reduction in IOP and hypotensive medication (AGD), change in visual acuity, success rates, and complications were computed by comparing preoperative data with data at 1 year postoperatively. RESULTS A total of 245 eyes of 245 subjects were included. Study eyes underwent phaco alone (38 eye) or combined phaco-ELT (105 eye) and phaco-aiT (102 eye). Phaco alone, combined phaco-ELT, and combined phaco-aiT lowered IOP by 1.5 ± 4.0 mmHg, 4.3 ± 5.6, and 5.3 ± 4.5 mmHg, respectively (P < 0.01). Survival time of phaco-ELT outreached survival time of phaco alone and combined phaco-aiT (20.6 ± 1.0 vs. 13.2 ± 0.4 and 12.9 ± 0.6 month, respectively). No serious complications or adverse events occurred. None of the cases required a subsequent procedure within the first year to lower IOP further. CONCLUSIONS All three surgical procedures lowered IOP and reduced medication. However, the IOP-lowering efficacy of the two combined MIGS procedures exceeded the effect of phaco alone. A combined phaco and MIGS procedures seem reasonable to consider whenever a cataract surgery in an eye with glaucoma or ocular hypertension is considered. In addition, the combined MIGS procedure effectively lowers IOP whenever a target IOP in the mid-teens is sufficient. In this study, the nonthermal phaco-ELT procedure showed superior efficacy at 1 year over phaco alone and phaco-aiT in the Kaplan-Meier statistics.
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Affiliation(s)
- Lidija Jozic
- University of Zurich, Faculty of Medicine, Pestalozzistrasse 3, 8091, Zurich, Switzerland.,nordBLICK Praxis Pinneberg, Bismarckstraße 6, 25421, Pinneberg, Germany
| | - Joachim Magner
- Qualitätsgemeinschaft Augenheilkunde Nord, Augentagesklinik Ballindamm, Ballindamm 37, 20095, Hamburg, Germany
| | - Jens Funk
- Department of Ophthalmology, University Hospital Zurich, Frauenklinikstrasse 24, 8091, Zurich, Switzerland
| | - Marc Töteberg-Harms
- Department of Ophthalmology, University Hospital Zurich, Frauenklinikstrasse 24, 8091, Zurich, Switzerland.
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Rezkallah A, Mathis T, Denis P, Kodjikian L. XEN gel stent: a total delayed-onset postoperative hyphema. Int J Ophthalmol 2019; 12:1224-1226. [PMID: 31341818 DOI: 10.18240/ijo.2019.07.27] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 02/19/2019] [Indexed: 11/23/2022] Open
Affiliation(s)
- Amina Rezkallah
- Department of Ophthalmology, Croix-Rousse University Hospital, University of Lyon, Lyon 69004, France
| | - Thibaud Mathis
- Department of Ophthalmology, Croix-Rousse University Hospital, University of Lyon, Lyon 69004, France.,UMR-CNRS 5510 Matéis, University of Medicine Lyon 1, Lyon 69008, France
| | - Philippe Denis
- Department of Ophthalmology, Croix-Rousse University Hospital, University of Lyon, Lyon 69004, France
| | - Laurent Kodjikian
- Department of Ophthalmology, Croix-Rousse University Hospital, University of Lyon, Lyon 69004, France.,UMR-CNRS 5510 Matéis, University of Medicine Lyon 1, Lyon 69008, France
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Samuelson TW, Sarkisian SR, Lubeck DM, Stiles MC, Duh YJ, Romo EA, Giamporcaro JE, Hornbeak DM, Katz LJ, Bartlett W, Buznego C, Johnson S, D'Ambrosio FA, Dehning D, DuBiner H, Goyal R, Hughes B, Marquis RE, Noecker R, Tauber S, Perez BR, Roel L, Sarkisian S, Silverstein S, Day S, Solomon K, Tyson F, Vold S, Samuelson T, Simmons S, Stiles M, Nguyen QH, Bashford KP, Flowers B, Flynn WJ, Gira J, Okeke C, Reiss GR, Tyson SL, Parkhurst G, Linn J, Lubeck D, Solomon J, Singh IP, Johnson RD, Lin C, Kim JW, Crane CJ, Cotter F. Prospective, Randomized, Controlled Pivotal Trial of an Ab Interno Implanted Trabecular Micro-Bypass in Primary Open-Angle Glaucoma and Cataract. Ophthalmology 2019; 126:811-821. [DOI: 10.1016/j.ophtha.2019.03.006] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 03/04/2019] [Accepted: 03/04/2019] [Indexed: 10/27/2022] Open
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Hohberger B, Haug M, Bergua A, Lämmer R. MIGS – eine Off-label-Option für eine therapierefraktäre, steroidinduzierte okuläre Hypertension. Ophthalmologe 2019; 117:62-65. [DOI: 10.1007/s00347-019-0898-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Hengerer FH, Auffarth GU, Riffel C, Conrad-Hengerer I. Prospective, Non-randomized, 36-Month Study of Second-Generation Trabecular Micro-Bypass Stents with Phacoemulsification in Eyes with Various Types of Glaucoma. Ophthalmol Ther 2018; 7:405-415. [PMID: 30430427 PMCID: PMC6258575 DOI: 10.1007/s40123-018-0152-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Indexed: 11/24/2022] Open
Abstract
Introduction The aim of this study was to assess 36-month outcomes after cataract surgery and implantation of two second-generation trabecular micro-bypass stents (iStent inject, Glaukos Corporation, San Clemente, CA, USA) into eyes with predominantly primary open-angle glaucoma (POAG) or pseudoexfoliative glaucoma (PEX). Methods This prospective, non-randomized, consecutive cohort study included eyes with POAG (n = 60), PEX (n = 15), appositional narrow-angle (n = 4), pigmentary (n = 1), or neovascular (secondary) (n = 1) glaucoma and cataract requiring surgery. All eyes (n = 81) underwent ab interno iStent inject implantation following cataract surgery. Effectiveness endpoints through 36 months included intraocular pressure (IOP), number of medications, and proportion of eyes with ≥ 20% IOP reduction, IOP ≤ 18 mmHg, and IOP ≤ 15 mmHg. Safety measures included corrected distance visual acuity (CDVA), adverse events, and secondary surgeries. Outcomes were evaluated for the overall cohort, and for the POAG and PEX subgroups. Results Preoperatively, 32.1% of eyes had undergone prior glaucoma surgery, 56% were on 3–4 medications, and 1 eye (1%) was medication-free. At 36 months postoperatively, mean IOP reduced by 37% (14.3 ± 1.7 mmHg versus 22.6 ± 6.2 mmHg preoperatively), and mean medication burden decreased by 68% (0.8 ± 0.9 versus 2.5 ± 1.1 medications preoperatively). IOP reduced by ≥ 20% in 78% of eyes; 100% of eyes reached IOP ≤ 18 mmHg and 71% reached ≤ 15 mmHg. Medication burden reduced considerably: 22 eyes (54%) were medication-free compared to 1 eye (1%) preoperatively; 1 eye (2%) required ≥ 3 medications compared to 45 eyes (56%) preoperatively; and 92.7% of eyes required reduced medications postoperatively. From 3 through 36 months, mean IOP remained ≤ 15.0 mmHg, and mean number of medications remained ≤ 0.9. Outcomes in the POAG and PEX subgroups included 33% and 32% lower IOP, and 68% and 64% fewer medications, respectively. iStent inject showed a favorable safety profile, including no intraoperative complications, minimal adverse events, and a stable CDVA. Conclusion This real-world cohort of eyes with various types of glaucoma and considerable disease burden exhibited durable and safe IOP and medication reductions through 36 months following iStent inject implantation with cataract surgery. Outcomes were similarly beneficial in eyes with POAG and PEX. Funding Article processing charges were funded by Glaukos Corporation (San Clemente, CA, USA).
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Affiliation(s)
- Fritz H Hengerer
- University Eye Hospital, University of Heidelberg, Heidelberg, Germany.
| | - Gerd U Auffarth
- University Eye Hospital, University of Heidelberg, Heidelberg, Germany
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Abstract
SIGNIFICANCE Noncompliance is a problem affecting glaucoma patients. Approaches to improve adherence include the use of drug-delivery systems and safer forms of surgery. Minimally invasive glaucoma surgery (MIGS) has reduced complications, particularly in combination with cataract surgery, and with its good intraocular pressure (IOP) reduction may reduce or eliminate glaucoma medications.Glaucoma is a progressive disease and a leading cause of irreversible blindness. Elevated IOP is the most important risk factor, but effective medical management is dependent on patient adherence. This review summarizes the adherence problem in glaucoma and the efforts, including MIGS, to provide effective IOP control that is not dependent on patient compliance.The current understanding of patient adherence to pharmacological treatment of glaucoma is discussed including the challenges facing glaucoma patients. Historical approaches to providing IOP control in a sustained and reliable way are presented culminating in a review of the burgeoning use of MIGS devices.It is estimated that, in the United States, 27% of prescriptions written, across all medications, are not filled or are filled but not taken. For ocular hypotensive medications, even when filled, a large percentage (which varies widely by study) are not instilled as prescribed. To address this problem, methods for sustained drug delivery have been and continue to be developed, as well as surgical and laser approaches. Most recently, MIGS devices have gained popularity because of the ease of implantation during cataract surgery, favorable safety profile, and the possibility for effective and long-lasting IOP lowering, as well as the reduction or elimination of need for IOP-lowering medication.Poor adherence to treatment is relatively common among glaucoma patients and is associated with progression of disease. Recommending MIGS implantation during cataract surgery may offer optometrists a valuable treatment option in managing glaucoma patients, particularly where good adherence is in doubt.
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Shah S, Rana M, Pandey P, Masood I. Endoscopic Goniosynechialysis for Acute Angle Closure Glaucoma Following Descemet\'s Stripping Automated Endothelial Keratoplasty. J Curr Glaucoma Pract 2018. [DOI: 10.5005/jp-journals-10028-1250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Elbably A, Othman TM, Mousa A, Elridy M, Badawy W, Elbably M. Deep Sclerectomy with Porous Collagen in Open-angle Glaucoma, Short-term Study. J Curr Glaucoma Pract 2018. [DOI: 10.5005/jp-journals-10028-1249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Popovic M, Campos-Moller X, Saheb H, Ahmed IIK. Efficacy and Adverse Event Profile of the iStent and iStent Inject Trabecular Micro-bypass for Open-angle Glaucoma: A Meta-analysis. J Curr Glaucoma Pract 2018; 12:67-84. [PMID: 30473602 PMCID: PMC6236117 DOI: 10.5005/jp-journals-10008-1248] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 07/27/2018] [Indexed: 11/23/2022] Open
Abstract
Aim This meta-analysis explores the efficacy and adverse event profile of the iStent, an ab interno implant for the treatment of open-angle glaucoma. Methods A systematic literature search of Ovid MEDLINE and EMBASE was used to identify peer-reviewed original studies that provided efficacy data on the first or second generation iStent for at least five eyes. Intraocular pressure (IOP) was the primary efficacy endpoint, while the number of medication classes was the secondary outcome. Weighted mean differences were reported for continuous endpoints, while a relative risk was computed for dichotomous variables. Review Results The search revealed 545 results, of which 1767 eyes from 28 studies were included. The cohort age was 71.4 ± 5.4 years, and 44.9% of patients were male. There was a significantly greater IOP reduction after the use of two first-generation stents compared to one, irrespective of phacoemulsification status (p < 0.001). Additionally, there was a significantly greater IOP reduction following iStent alone relative to phaco-iStent for the first-generation iStent (p < 0.001) and the iStent inject (p < 0.001). For the first generation stent, combined phaco-iStent provided a greater level of IOP reduction (p < 0.001) and reduction in the number of medication classes relative to phacoemulsification alone (p < 0.001). In total, 22.5% of eyes that received iStent implantation sustained some type of adverse event. The most common adverse events were intraocular pressure elevation, stent blockage or obstruction, stent malposition and hyphema. Conclusion and Clinical Significance Statistically significant differences in efficacy outcomes exist between different numbers of stents and the presence or absence of concurrent phacoemulsification. How to cite this article: Popovic M, Campos-Moller X, Saheb H, Ahmed IIK. Efficacy and Adverse Event Profile of the iStent and iStent Inject Trabecular Micro-bypass for Open-angle Glaucoma: A Meta-analysis. J Curr Glaucoma Pract 2018;12(2):67-84.
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Affiliation(s)
- Marko Popovic
- Research Assistant, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Xavier Campos-Moller
- Ophthalmologist, Western Health Eye Care Centre, Corner Brook, Newfoundland, Canada
| | - Hady Saheb
- Ophthalmologist, Department of Ophthalmology, McGill University, Montreal, Quebec, Canada
| | - Iqbal Ike K Ahmed
- Ophthalmologist, Department of Ophthalmology and Vision Sciences, University of Toronto, Mississauga, Ontario, Canada
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Agrawal P, Bradshaw SE. Systematic Literature Review of Clinical and Economic Outcomes of Micro-Invasive Glaucoma Surgery (MIGS) in Primary Open-Angle Glaucoma. Ophthalmol Ther 2018; 7:49-73. [PMID: 29725860 PMCID: PMC5997597 DOI: 10.1007/s40123-018-0131-0] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Primary open-angle glaucoma is estimated to affect 3% of the population aged 40-80 years. Trabeculectomy is considered the gold standard in surgical management of glaucoma; however, it is a technically complex procedure that may result in a range of adverse outcomes. Device-augmented, minimally invasive procedures (micro-invasive glaucoma surgeries, MIGS) have been developed aiming for safer and less invasive intraocular pressure (IOP) reduction compared with traditional surgery. METHODS This paper presents results from a systematic literature review conducted in accordance with National Institute for Health and Care Excellence requirements for the Medical Technology Evaluation Programme via multiple databases from 2005 to 2016. For clinical outcomes, randomized clinical trials (RCTs) comparing MIGS with trabeculectomy or other therapies, observational studies, and other non-RCTs were included. Clinical outcomes reviewed were the change from baseline in mean IOP levels and change in topical glaucoma medication. Safety was assessed by reported harm and adverse events. For economic evidence, trials on cost-effectiveness, cost-utility, cost-benefit, cost-consequences, cost-minimization, cost of illness, and specific procedure costs were included. Risk of bias was assessed for clinical studies using the Cochrane Risk of Bias tool. RESULTS A total of nine RCTs (seven iStents®, one Hydrus®, and one CyPass®), seven non-RCTs (three iStent®, three CyPass®, and one Hydrus®), and 23 economic studies were analyzed. While various forms of trabeculectomy can achieve postoperative IOP of between 11.0 and 13.0 mmHg, MIGS devices described in this review were typically associated with higher postoperative IOP levels. In addition, MIGS devices may result in increased hypotony rates or bleb needling in subconjunctival placed devices, requiring additional medical resources to manage. There is limited available evidence on the cost-effectiveness of MIGS and therefore it remains unclear whether the cost of using MIGS is outweighed by cost savings through decreased medication and need for further interventions. CONCLUSION Larger randomized trials and real-world observational studies are needed for MIGS devices to better assess clinical and economic effectiveness. Given the shortage of published data and increasing use of such procedures, living systematic reviews may help to provide ongoing and timely evidence-based direction for clinicians and decision makers. This review highlights the current unmet need for treatments that are easy to implement and reduce long-term IOP levels without increasing postoperative aftercare and cost. FUNDING Santen GmbH, Germany.
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Affiliation(s)
- Pavi Agrawal
- Nottingham University Hospital Queens Medical Centre, Nottingham, UK
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Widder RA, Dietlein TS, Dinslage S, Kühnrich P, Rennings C, Rössler G. The XEN45 Gel Stent as a minimally invasive procedure in glaucoma surgery: success rates, risk profile, and rates of re-surgery after 261 surgeries. Graefes Arch Clin Exp Ophthalmol 2018; 256:765-771. [PMID: 29356886 DOI: 10.1007/s00417-018-3899-7] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 12/27/2017] [Accepted: 01/03/2018] [Indexed: 10/18/2022] Open
Abstract
PURPOSE The XEN45 Gel Stent is a flexible hydrophilic tube placed under the conjunctiva via the anterior chamber. This study investigates the IOP (intraocular pressure)-lowering potential, the risk profile, and the success rate of the XEN45 Gel Stent. METHODS Two hundred and sixty-one eyes underwent surgery. The mean follow-up time was 8.5 months. The aim of the treatment was to achieve adequate IOP reduction without medication. Therefore, all patients who did not show sufficiently reduced IOP underwent a surgical revision with opening of the conjunctiva. To determinate the success rate, we carried out two kinds of analysis: 1) the primary success rate: eyes with appropiate IOP control without medication or surgical revision, and 2) overall success rate: one surgical revision was allowed. RESULTS Intraocular pressure was lowered from 24.3 mmHg (SD 6.6) to 16.8 mmHg (SD 7.6), and the medication score was lowered from 2.6 (SD 1.1) to 0.2 (SD 0.7). Revisional surgery was performed in 80 eyes (34%). After a first revision, intraocular pressure was lowered to 14.0 mmHg (SD 5.1), and the medication score was lowered to 0.2 (SD 0.6). The primary success rate was 66% and the overall success rate 90%. The primary success rate was higher in pseudophakic eyes (73%) than in phakic eyes (53%) or combined surgery (55%). CONCLUSIONS We conclude from our data that the XEN45 Gel Stent has an IOP-lowering potential and few side-effects. Pseudophakic eyes seem to have a better primary prognosis compared to combined surgery or surgery in phakic eyes.
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Affiliation(s)
- Randolf A Widder
- Department of Ophthalmology, St. Martinus-Krankenhaus Düsseldorf, Gladbacher Str. 26, D-40219, Düsseldorf, Germany. .,Department of Ophthalmology, University of Cologne, Cologne, Germany.
| | - Thomas S Dietlein
- Department of Ophthalmology, University of Cologne, Cologne, Germany
| | | | - Pia Kühnrich
- Department of Ophthalmology, St. Martinus-Krankenhaus Düsseldorf, Gladbacher Str. 26, D-40219, Düsseldorf, Germany
| | - Corinna Rennings
- Department of Ophthalmology, St. Martinus-Krankenhaus Düsseldorf, Gladbacher Str. 26, D-40219, Düsseldorf, Germany
| | - Gernot Rössler
- Department of Ophthalmology, St. Martinus-Krankenhaus Düsseldorf, Gladbacher Str. 26, D-40219, Düsseldorf, Germany.,Department of Ophthalmology, RWTH Aachen, Aachen, Germany
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Singh K, Mutreja A, Bhattacharyya M, Dangda S, Jaisingh K. Bilateral Phacomatosis Pigmentovascularis in a Young Male with Developmental Glaucoma and Varicose Veins. J Curr Glaucoma Pract 2018. [DOI: 10.5005/jp-journals-10028-1251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Popovic M, Campos-Möller X, Saheb H, Ahmed IIK. Efficacy and Adverse Event Profile of the iStent and iStent Inject Trabecular Micro-bypass for Open-angle Glaucoma: A Meta-analysis. J Curr Glaucoma Pract 2018. [DOI: 10.5005/jp-journals-10028-1248] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Minimally-invasive glaucoma surgeries (MIGS) for open angle glaucoma: A systematic review and meta-analysis. PLoS One 2017; 12:e0183142. [PMID: 28850575 PMCID: PMC5574616 DOI: 10.1371/journal.pone.0183142] [Citation(s) in RCA: 275] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 07/31/2017] [Indexed: 11/19/2022] Open
Abstract
Background MIGS have been developed as a surgical alternative for glaucomatous patients. Purpose To analyze the change in intraocular pressure (IOP) and glaucoma medications using different MIGS devices (Trabectome, iStent, Excimer Laser Trabeculotomy (ELT), iStent Supra, CyPass, XEN, Hydrus, Fugo Blade, Ab interno canaloplasty, Goniscopy-assisted transluminal trabeculotomy) as a solo procedure or in association with phacoemulsification. Methods Randomized control trials (RCT) and non-RCT (non randomized comparative studies, NRS, and before-after studies) were included. Studies with at least one year of follow-up in patients affected by primary open angle glaucoma, pseudoexfoliative glaucoma or pigmentary glaucoma were considered. Risk of Bias assessment was performed using the Cochrane Risk of Bias and the ROBINS-I tools. The main outcome was the effect of MIGS devices compared to medical therapy, cataract surgery, other glaucoma surgeries and other MIGS on both IOP and use of glaucoma medications 12 months after surgery. Outcomes measures were the mean difference in the change of IOP and glaucoma medication compared to baseline at one and two years and all ocular adverse events. The current meta-analysis is registered on PROSPERO (reference n° CRD42016037280). Results Over a total of 3,069 studies, nine RCT and 21 case series with a total of 2.928 eyes were included. Main concerns about risk of bias in RCTs were lack of blinding, allocation concealment and attrition bias while in non-RCTs they were represented by patients’ selection, masking of participants and co-intervention management. Limited evidence was found based on both RCTs and non RCTs that compared MIGS surgery with medical therapy or other MIGS. In before-after series, MIGS surgery seemed effective in lowering both IOP and glaucoma drug use. MIGS showed a good safety profile: IOP spikes were the most frequent complications and no cases of infection or BCVA loss due to glaucoma were reported. Conclusions Although MIGS seem efficient in the reduction of the IOP and glaucoma medication and show good safety profile, this evidence is mainly derived from non-comparative studies and further, good quality RCTs are warranted.
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Safety and Efficacy of Microinvasive Glaucoma Surgery. J Ophthalmol 2017; 2017:3182935. [PMID: 28512578 PMCID: PMC5420434 DOI: 10.1155/2017/3182935] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 03/20/2017] [Indexed: 01/27/2023] Open
Abstract
Microinvasive glaucoma surgery (MIGS) is emerging as a new therapeutic option for glaucoma patients who wish to reduce their medication burden and avoid the postoperative complications of conventional glaucoma filtration surgery. These devices differ in terms of their efficacy and safety profile. Schlemm's canal devices have the most favorable safety profile at the compromise of modest efficacy, while subconjunctival and suprachoroidal devices are potentially more effective at lowering the intraocular pressure at the expense of a higher rate of complications. This review consolidates the latest evidence on the efficacy and safety of the MIGS devices in clinical use and provides an overview on upcoming devices which would likely also become viable treatment options in the near future. These clinical data would assist a glaucoma surgeon in selecting the most appropriate MIGS device for each patient based on the glaucoma severity and patient expectations.
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