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Editors Selection IGR 12-4
Surgical Treatment: Phaco-and-Stent
Comment by Malik Kahook on:
61132 A Randomized Trial of a Schlemm's Canal Microstent with Phacoemulsification for Reducing Intraocular Pressure in Open-Angle Glaucoma, Pfeiffer N; Garcia-Feijoo J; Martinez-de-la-Casa JM et al., Ophthalmology, 2015; 122: 1283-1293
Micro-incisional glaucoma surgery (MIGS) has become a viable option for treating mild to moderate glaucoma with an attractive risk-benefit profile for many patients. MIGS options that are widely available for patient care include procedures that do not require device implantation, such as endocyclophotocoagulation (Beaver Visitec) and Trabectome (Neomedix), as well as implant-based procedures such as the iStent (Glaukos Laguna, Hills CA). Another implantable option is the Hydrus Microstent (Ivantis, Inc, Irvine, CA). The microstent is implanted ab interno through a clear corneal incision into the canal of Schlemm allowing aqueous humor outflow to bypass the trabecular meshwork while dilating the canal over three clock hours. A recent prospective multi-center trial was completed to assess the safety and efficacy of the Hydrus Microstent combined with cataract surgery (CS) for reducing intraocular pressure (IOP) in eyes with open-angle glaucoma (OAG). A total of 100 eyes from 100 patients with IOP < 24 mmHg and four or fewer glaucoma medications were enrolled in the study and randomized 1:1 to either CS with Hydrus or CS alone. All patients had a washed-out diurnal IOP (DIOP) of 21 to 36 mmHg. The proportion of patients with a 20% reduction in washed-out DIOP was 80% in the Hydrus plus CS group at 24 months compared with 46% in the CS alone group (P = 0.0008). Washed-out mean DIOP in the Hydrus plus CS group was 16.9 ± 3.3 mmHg at 24 months compared with 19.2 ± 4.7 mmHg in the CS alone group (P = 0.0093). Seventy-three percent in the Hydrus-plus CS group vs 38% in the CS-only group were off glaucoma medications at 24 months (P = 0.0008). Adverse events were similar between groups. This study shows the potential for Hydrus to significantly and safely lower IOP in patients with OAG who also require cataract extraction. Future studies that compare efficacy and safety of Hydrus versus existing MIGS devices, such as the iStent, will help physicians and patients select the most appropriate therapy for optimal results.
References
- Pircher M, Hitzenberger CK, Schmidt-Erfurth U. Polarization sensitive optical coherence tomography in the human eye. Prog Retin Eye Res 2011;30(6):431-451.
- Vermeer KA, van der Schoot J, Lemij HG, de Boer JF. RPE-normalized RNFL attenuation coefficient maps derived from volumetric OCT imaging for glaucoma assessment. Invest Ophthalmol Vis Sci 2012;53(10):6102-6108
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