Conventional glaucoma implants and the new MIGS devices: a comprehensive review of current options and future directions

Pereira, Inês C.; Wijdeven, Rosanne van de; Wyss, Hans M.; Beckers, Henny J. M.; Toonder, Jaap M.J. den

doi:10.1038/s41433-021-01595-x

Cited by 71 publications

(89 citation statements)

References 119 publications

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“…While this study investigated iStent, the second-generation iStent inject [ 41 ] and its enhanced iStent inject W [ 46 ] have since been commercially released and consist of two micro stents preloaded into a single-use injector. The stents have the same mechanism of action as iStent but create two bypasses through the trabecular meshwork and comprise a central outlet and four side flow outlets to provide multidirectional flow in Schlemm’s canal.…”

Section: Discussionmentioning

confidence: 99%

iStent Trabecular Micro-bypass Stent Implantation Combined with Phacoemulsification for Open-Angle Glaucoma: A 2-Year Post-marketing Surveillance Study in Japan

Inatani

Kohama²,

Chu³

2022

Adv Ther

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Introduction We report 2-year outcomes after implantation of iStent trabecular micro-bypass stent with phacoemulsification, in Japanese patients with mild–moderate open-angle glaucoma (OAG). Methods This was a 24-month, prospective, longitudinal, observational, post-marketing study conducted between July 2017 and September 2020. Patients consisted of adults with OAG on antiglaucoma medications who had cataract surgery combined with one iStent implantation. Outcome measures included intraocular pressure (IOP), antiglaucoma medications, treatment success rates (defined as eyes having lower IOP with same or reduced number of medications from baseline, or same IOP with reduced number of medications from baseline, and not requiring secondary glaucoma surgeries postoperatively), and safety. Outcomes were analyzed in the overall cohort and in glaucoma subtypes: primary OAG, normal-tension glaucoma, and exfoliative glaucoma. Results Overall, 232 eyes were enrolled. At 24 months, mean ± standard deviation IOP decreased from 17.6 ± 4.0 mmHg preoperatively to 14.3 ± 3.0 mmHg ( p < 0.05), and mean number of medications reduced from 2.2 ± 1.2 preoperatively to 0.7 ± 1.2 ( p < 0.05). Similar trends were observed across glaucoma subtypes. In the overall cohort, 96.7%, 95.3%, and 93.7% of patients achieved treatment success at 6, 12, and 24 months, respectively. There were 67.6% medication-free eyes at 24 months compared to 3.2% medication-free eyes preoperatively ( p < 0.0001). Safety profile was favorable over the 2-year period. Conclusions Following iStent implantation with phacoemulsification, clinically relevant and statistically significant reductions in IOP and number of medications were observed in Japanese eyes with OAG over 2 years, with favorable safety profile. These reductions were observed across all glaucoma subtypes. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-022-02207-0.

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Section: Discussionmentioning

confidence: 99%

iStent Trabecular Micro-bypass Stent Implantation Combined with Phacoemulsification for Open-Angle Glaucoma: A 2-Year Post-marketing Surveillance Study in Japan

Inatani

Kohama²,

Chu³

2022

Adv Ther

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“…Modifications induced by the GMS into the anterior chamber, aqueous humour and supraciliary space may contribute to elucidate possible mechanisms of failure. Because of the elevated rates of failure and the serious complications reported in some case postoperatively, the GMS never received Food and Drug Administration approval (Hueber et al 2013;Pereira et al 2021).…”

Section: Discussionmentioning

confidence: 99%

Long‐term outcome of supraciliary gold micro shunt in refractory glaucoma

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Loiudice

Passani

et al. 2021

Acta Ophthalmologica

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Purpose To evaluate the 10‐year follow‐up efficacy and safety of gold micro shunt (GMS) in patients with refractory glaucoma, and the potential risk factors for failure. Methods Retrospective data analyses based on medical records from 55 patients who underwent GMS implant for refractory glaucoma between March 2007 and April 2008. The primary outcome measure was the cumulative probability of success defined as intraocular pressure (IOP) below 21 mmHg together with a 33% lowering of the baseline IOP with (qualified) or without (complete) topical medications, no reoperation for glaucoma or loss of light perception. Results Mean IOP 10 years after the GMS implantation was 21.6 ± 5.1 mmHg with 2.7 ± 0.7 drugs. Qualified success was achieved in 8/55 patients (14.5%) with a mean of 2.9 ± 0.8 drugs at 5 years and in 2/55 patients (3.6%) with a mean of 2.7 ± 1.0 drugs at 10 years. None of the patients reached complete success at five years from surgery. The cumulative probability of complete success was 14%, 9% and 0% at 1, 2 and 5 years, respectively, and 72%, 67%, 36% and 3.6% at 1, 2, 5 and 10 years, respectively, for qualified success criterion. Baseline IOP for complete success, number of baseline medication for qualified success and age at the time of GMS implantation for both criteria were risk factors significantly associated with failure. Conclusion A very low long‐term survival rate of GMS in refractory glaucoma was found. Most patients did not reach the IOP success criteria of the study, even with the re‐introduction of medications, leading to the need for further surgical procedures.

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“…The first group has yielded promising results in adult and pediatric glaucoma by creating a circumferential incision into SC and reducing the resistance to aqueous outflow (36)(37)(38)(39). Another one develops new MIGS devices to provide an alternative pathway through which aqueous humor can effectively exit the anterior chamber, reducing IOP (40)(41)(42). MIGS is widely becoming the front-line glaucoma surgery with respect to various advantages (43)(44)(45)(46)(47)(48).…”

Section: Glaucomamentioning

confidence: 99%

Grand Challenges and Opportunities in Surgical Ophthalmology: Together for a Shared Future

et al. 2022

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Conventional glaucoma implants and the new MIGS devices: a comprehensive review of current options and future directions

Cited by 71 publications

References 119 publications

iStent Trabecular Micro-bypass Stent Implantation Combined with Phacoemulsification for Open-Angle Glaucoma: A 2-Year Post-marketing Surveillance Study in Japan

iStent Trabecular Micro-bypass Stent Implantation Combined with Phacoemulsification for Open-Angle Glaucoma: A 2-Year Post-marketing Surveillance Study in Japan

Long‐term outcome of supraciliary gold micro shunt in refractory glaucoma

Grand Challenges and Opportunities in Surgical Ophthalmology: Together for a Shared Future

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