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Editors Selection IGR 17-4

Surgical Treatment: Drainage devices

Comment by Lawrence Kagemann on:

53874 Optical coherence tomography of the suprachoroid after CyPass Micro-Stent implantation for the treatment of open-angle glaucoma, Saheb H; Ianchulev T; Ahmed II, British Journal of Ophthalmology, 2014; 98: 19-23

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Saheb and colleagues quantified the pooling of aqueous humor in the supraciliary space using anterior segment OCT imaging in a retrospective observational study of patients receiving CyPass microstent implants. They conclude that anterior segment OCT imaging is sufficient for assessment of fluid drainage after implant. While the conclusion is supported by the data, it under-represents the importance of the actual quantification of fluid pooling parameters, nor were the aqueous pooling parameters compared to IOP reduction. There were a sufficient number of eyes (35 recruited with 17 imaged at six months and 19 at 12 months) to detect a relationship between the magnitude of IOP change and the aqueous humor pooling parameters created for this study. Future application of aqueous humor outflow structure morphology parameters in the clinical management of glaucoma requires an understanding of their relationship with IOP regulation.

The present data set infers, but neither proves nor tests, an association between aqueous humor pooling in the supraciliary space and IOP reduction with implantation of the CyPass

The present data set infers, but neither proves nor tests, an association between aqueous humor pooling in the supraciliary space and IOP reduction with implantation of the CyPass. In fact, this retrospective observational study has no stated hypothesis, nor do the methods describe any statistical comparisons. In a purely descriptive study, the authors do not state whether longitudinal changes in aqueous humor pooling around the stent change significantly over time. The authors are encouraged to provide a more thorough analysis of the data. Also, since pre-surgical scans may not be available, it might be useful to obtained comparative scans in normal and glaucomatous eyes to provide comparative measures of supraciliary space size. Even if the equivalent location presents as closed in those eyes, it would be helpful to have images in an eye without implantation of a stent.

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