Second-generation Trabecular Meshwork Bypass Stent (iStent inject) Increases Outflow Facility in Cultured Human Anterior Segments

Bahler, Cindy K.; Hann, Cheryl R.; Fjield, Todd; Haffner, D.; Heitzmann, Hal; Fautsch, Michael P.

doi:10.1016/j.ajo.2011.12.017

Cited by 103 publications

(88 citation statements)

References 21 publications

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“…At the time of this report, laboratory evidence for improvement in outflow resistance has been reported only for intracanalicular procedures. 17,18 Such evidence is critical in validating the claimed mechanism of action for procedures that improve outflow. In a research setting, a single variable (microstent versus sham) can be controlled while eliminating or keeping other variables constant.…”

Section: Discussionmentioning

confidence: 99%

A Novel 8-mm Schlemm's Canal Scaffold Reduces Outflow Resistance in a Human Anterior Segment Perfusion Model

Gulati

Fan

Hays

et al. 2013

Invest. Ophthalmol. Vis. Sci.

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PURPOSE.To study the effect on outflow facility and outflow resistance of a nitinol microstent implanted into Schlemm's canal.METHODS. Using a constant pressure perfusion method, outflow facility and outflow resistance were measured in 26 pairs of dissected anterior segments from donated human eyes. Measurements were made at perfusion pressures of 10, 20, 30 and 40 mm Hg. The Hydrus Microstent was placed in Schlemm's canal of one eye and the contralateral eye underwent a sham procedure. Outflow facility and outflow resistance were measured again after the microstent implantation or sham procedure.RESULTS. The Hydrus Microstent significantly increased outflow facility from 0.33 6 0.17 lL/min/mm Hg to 0.52 6 0.19 lL/ min/mm Hg (P < 0.001). Outflow resistance was significantly reduced from 4.38 6 3.03 mm Hg/lL/min at baseline to 2.34 6 1.04 mm Hg/lL/min (P < 0.001) with the microstent. There was a linear correlation between outflow resistance at baseline and decrease in outflow resistance with the microstent (R 2 ¼ 0.89, P < 0.0001).CONCLUSIONS. The increase in outflow facility and decrease in resistance supports the potential use of the Hydrus Microstent as a surgical option to reduce intraocular pressure (IOP). The IOP-lowering effect may be higher in eyes with higher outflow resistance (and IOP) as compared with eyes with lower outflow resistance (and IOP). (Invest Ophthalmol Vis Sci.

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Section: Discussionmentioning

confidence: 99%

A Novel 8-mm Schlemm's Canal Scaffold Reduces Outflow Resistance in a Human Anterior Segment Perfusion Model

Gulati

Fan

Hays

et al. 2013

Invest. Ophthalmol. Vis. Sci.

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“…32 Devices currently being inserted into SC in the operating room to bypass the TM are thought to achieve their best effect when placed near CCO; at the same time, efforts are made to avoid damage to or occlusion of CCO. The positioning of MIGS devices has been evaluated through imaging with SEM, 45,46 but not OCT. Device placement requirements illustrate the need for in vivo imaging tools to inform device development and to optimize device placement, thereby enabling improvement of clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Platform to investigate aqueous outflow system structure and pressure-dependent motion using high-resolution spectral domain optical coherence tomography

et al. 2014

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Abstract. The aqueous outflow system (AOS) is responsible for maintaining normal intraocular pressure (IOP) in the eye. Structures of the AOS have an active role in regulating IOP in healthy eyes and these structures become abnormal in the eyes with glaucoma. We describe a newly developed system platform to obtain high-resolution images of the AOS structures. By incorporating spectral domain optical coherence tomography (SD-OCT), the platform allows us to systematically control, image, and quantitate the responses of AOS tissue to pressure with a millisecond resolution of pulsed flow. We use SD-OCT to image radial limbal segments from the surface of the trabecular meshwork (TM) with a spatial resolution of ∼5 μm in ex vivo nonhuman primate eyes. We carefully insert a cannula into Schlemm's canal (SC) to control both pressures and flow rates. The experimental results demonstrate the capability of the platform to visualize the unprecedented details of AOS tissue components comparable to that delivered by scanning electron microscopy, as well as to delineate the complex pressure-dependent relationships among the TM, structures within the SC, and collector channel ostia. The described technique provides a new means to characterize the anatomic and pressure-dependent relationships of SC structures, particularly the active motion of collagenous elements at collector channel ostia; such relationships have not previously been amenable to study. Experimental findings suggest that continuing improvements in the OCT imaging of the AOS may provide both insights into the glaucoma enigma and improvements in its management.

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“…Последний лишен Г-образного изгиба и несколько короче, представляя со-бой прямую трубочку-муфту, и предназначен для непо-средственной имплантации через трабекулярную сеть в шлеммов канал. В США он имеет статус неутвержденного устройства, но получил маркировку ЕС [25,29,30].…”

Section: вестник офтальмологии 3 2016unclassified

Modern methods of minimally invasive glaucoma surgery

et al. 2016

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Глаукома является одной из основных причин слабо-видения и слепоты во всем мире, а повышенный уровень внутриглазного давления (ВГД) служит доказанным фак-тором риска ее развития и прогрессирования, что обу-словливает основную задачу лечения глаукомы -сниже-ние ВГД. Решение этой задачи реализуется посредством © Коллектив авторов, 2016 хирургия глауком, берущая свое начало от иридэктомии по A. Graefe, постепенно эволюционировала от травматичных операций, выполняемых без увеличительной оптики и микрохирургического инструментария, до высокотехнологичных микроскопических патогенетически ориентированных вмешательств. В последние десятилетия «золотым стандартом» являются модификации трабекулэктомии, предложенной J. Cairns в 1968 г. однако, несмотря на ее высокий и продолжительный гипотензивный эффект, такие распространенные осложнения, как отслойка сосудистой оболочки и гифема, стимулировали развитие так называемых нефистулизирующих операций. Наиболее широкое распространение получило направление непроникающих вмешательств, включающих глубокую склерэктомию и вискоканалостомию. Их высокий профиль безопасности тем не менее сопровождался непродолжительным гипотензивным эффектом. Как фистулизирующие трабекулэктомии, так и непроникающие вмешательства захватывают зону лимба и конъюнктивы, что существенно снижает возможность проведения повторных операций. данный факт в совокупности с недостатками вышеописанных вмешательств, а также развитие современных высокоточных технологий создали предпосылки для появления нового направления -минимально инвазивной глаукомной хирургии (МИГх). В настоящее время обсуждаются параметры, согласно которым те или иные вмешательства попадают под определение МИГх, однако базовым критерием считается доступ ab interno через роговичный разрез. По мере модернизации уже существующих устройств и появления новых возможностей хирургического лечения глаукомы существенно расширяются, что в дальнейшем позволит перейти на более высокий уровень стандартов лечения глаукомы. В данном обзоре представлены все микроинвазивные техники глаукомной хирургии, уже используемые в практике или находящиеся на стадии клинических исследований. Проанализированы статьи, посвященные эффективности данной хирургии, и сделаны выводы о состоянии МИГх на сегодняшний день. Over the years, glaucoma surgery has improved from iridectomy by A. Graefe and traumatizing procedures performed without magnification tools or microsurgical instrument to high-technology interventions that are not only microscopic, but also pathogenetically oriented. Various modifications of trabeculectomy, initially introduced by J. Cairns back in 1968, had been the gold standard for several decades and were notable for pronounced and stable hypotensive effects. However, there was also a strong association with such complications as choroidal detachment and hyphema, thus, boosting the development of so called nonfistulizing surgeries. Of the latter, the most widely used are non-penetrating procedures, including deep sclerectomy and viscocanalostomy. Although very saf...

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Second-generation Trabecular Meshwork Bypass Stent (iStent inject) Increases Outflow Facility in Cultured Human Anterior Segments

Cited by 103 publications

References 21 publications

A Novel 8-mm Schlemm's Canal Scaffold Reduces Outflow Resistance in a Human Anterior Segment Perfusion Model

A Novel 8-mm Schlemm's Canal Scaffold Reduces Outflow Resistance in a Human Anterior Segment Perfusion Model

Platform to investigate aqueous outflow system structure and pressure-dependent motion using high-resolution spectral domain optical coherence tomography

Modern methods of minimally invasive glaucoma surgery

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