Three-Year Findings of the HORIZON Trial

Ahmed, Iqbal Ike K.; Rhee, Douglas J.; Jones, Jason J.; Singh, Inder Paul; Radcliffe, Nathan M.; Gazzard, Gus; Samuelson, Thomas W.; Ong, Jeb Alden; Singh, Kuldev

doi:10.1016/j.ophtha.2020.11.004

Cited by 53 publications

(28 citation statements)

References 25 publications

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“…Some evidence suggests that the effect of trabecular bypass during the time of cataract surgery is sustained for at least 5 years 47,48. The 3-year findings of the HORIZON trial demonstrate that this may also apply to the HMS 49. According to our model, HMS must not lose more than 33% efficacy per year between years 3 and 10 to still be cost-effective at 10 years.…”

Section: Discussionmentioning

confidence: 80%

Cost Utility of Schlemm’s Canal Microstent Injection With Cataract Surgery for Open-angle Glaucoma in the US Medicare System

Atik

Rhodes

Samuels

et al. 2022

Journal of Glaucoma

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Précis: Hydrus microstent (HMS) implantation at the time of cataract surgery appears to be cost-effective in mild-to-moderate glaucoma. However, long-term follow-up is essential for a full assessment of device performance, safety and cost-effectiveness. Purpose: The aim was to assess the societal cost-utility to the US Medicare system of implanting HMS with cataract surgery versus cataract surgery alone in patients with open-angle glaucoma. Patients: Markov model cohort of patients with mild-to-moderate open-angle glaucoma and visually significant cataract. Methods: Patients received HMS during cataract surgery versus cataract surgery alone, in a deterministic model over a 2-year horizon using TreeAge software. Both arms received additional ocular hypotensive agents to control intraocular pressure. Treatment effect of HMS was measured as mean number of ocular hypotensive medications and intraocular pressure, which directly impacted transition probabilities. Health states included the Hodapp-Parrish-Anderson glaucoma stages (mild, moderate, advanced, blind) and death. One-way sensitivity and probabilistic sensitivity analyses were conducted on device efficacy and longer time horizons. Results: At 2 years, HMS with cataract surgery in mild glaucoma had an incremental cost-utility ratio of USD 38,346.43 per utility gained, compared with cataract surgery alone. Probabilistic sensitivity analysis was cost-effective in 61.4% of iterations for HMS+cataract surgery. The probability of side-effects with eye drops, utility decrement with side-effects, cost of the HMS and real-world efficacy rate had the greatest impact on model outcomes. HMS must be 85.60% as effective as published data to maintain cost-effectiveness at a willingness-to-pay threshold of USD 50,000. The incremental cost-utility ratio of HMS with cataract surgery in moderate glaucoma was USD 42,895.38. Conclusions: HMS implantation during cataract surgery appears to be cost-effective for patients with mild-to-moderate glaucoma. Nevertheless, more long-term safety and efficacy data are required.

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Section: Discussionmentioning

confidence: 80%

Cost Utility of Schlemm’s Canal Microstent Injection With Cataract Surgery for Open-angle Glaucoma in the US Medicare System

Atik

Rhodes

Samuels

et al. 2022

Journal of Glaucoma

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“… 23 Similarly, for Hydrus implantation, the nasal anterior chamber angle was visualized and the device was inserted into Schlemm’s canal, as previously described. 24 , 25 For Xen stent placement, 0.1 mL mitomycin C 0.01% was injected in the intended quadrant of device insertion through the subconjunctiva. An ab interno approach was used where the anterior chamber angle was visualized and the device was inserted into the subconjunctival space using previously described technique.…”

Section: Methodsmentioning

confidence: 99%

“…23 Similarly, for Hydrus implantation, the nasal anterior chamber angle was visualized and the device was inserted into Schlemm's canal, as previously described. 24,25 For Xen stent placement, 0.1 mL mitomycin C 0.01% was injected in the intended quadrant of device insertion through the subconjunctiva.…”

Section: Surgical Proceduresmentioning

confidence: 99%

Clinical and Visual Field Outcomes Following Minimally Invasive Glaucoma Surgery Combined with Cataract Surgery

Turner¹,

Taha²,

Yonamine³

et al. 2022

OPTH

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Purpose To determine the change in Humphrey visual field and clinical parameters after minimally invasive glaucoma surgery combined with cataract surgery. Patients and Methods Patients undergoing minimally invasive glaucoma surgery combined with cataract surgery in a multicenter retrospective case series between 2013 and 2021 with reliable preoperative and 12 to 18 month postoperative visual field measurements were included. Devices included iStent, XEN, and Hydrus. Clinical parameters were compared with a generalized linear model with generalized estimating equations between preoperative and postoperative visits including best corrected visual acuity, intraocular pressure, number of glaucoma medications and visual fields. Visual field metrics included mean deviation (MD), pattern standard deviation (PSD), visual field index (VFI), and Collaborative Initial Glaucoma Treatment Study (CIGTS) score of total deviation probability and pattern deviation probability. Results Forty-four eyes from 39 patients were included. During the follow up period, visual acuity improved from 0.23±0.17 to 0.10±0.14 logMAR (mean ± standard deviation, p <0.001), number of glaucoma medications was reduced from 2.68±1.06 to 1.46±1.32 ( p <0.001), and intraocular pressure decreased from 17.08±4.23 mmHg to 14.92±3.13 mmHg ( p =0.003). Differences across devices were negligible. The only significant difference was a greater reduction in number of glaucoma medications in the XEN group ( p <0.001). There were no significant changes in the global parameters of VFI, MD, PSD, or CIGTS. Conclusion Overall, minimally invasive glaucoma surgery combined with cataract surgery appears to be effective at stabilizing visual field function, reducing intraocular pressure, reducing number of glaucoma medications, and improving visual acuity over a 12 to 18 month follow-up period across MIGS devices.

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“…They can be divided into traditional MIGS procedures, which augment aqueous outflow through the TM, and bleb-forming MIGS procedures, which shunt aqueous to the subconjunctival space, bypassing the TM. Traditional procedures, such as the implantation of iStents (Glaukos), Hydrus Microstents (Ivantis Inc.), and Kahook Dual Blade incision (New World Medical), seem well suited for combined surgery with phacoemulsification and achieve moderate IOP reduction with minimal postoperative complications 21–24 . Gonioscopy-assisted transluminal trabeculotomy (GATT) may demonstrate improved IOP reduction at the expense of increased postoperative complications 24–26 .…”

mentioning

confidence: 99%

Outcomes of XEN Stent in Patients With Glaucoma and Previous Corneal Transplantation

Oliver

Gupta

Yeung

et al. 2023

Journal of Glaucoma

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The XEN stent safely and effectively controls intraocular pressure in select patients with history of corneal transplantation.Purpose: Glaucoma is a common complication after corneal transplantation and can be difficult to manage in these patients. This study reports outcomes of XEN stent implantation in eyes with glaucoma in the setting of previous corneal transplantation.Patients and Methods: Noncomparative retrospective case series including eyes with a history of corneal transplantation and subsequent XEN stent implantation by a single glaucoma surgeon in Surrey, British Columbia, between 2017 and 2022. The analysis included patient demographics, pre and postoperative intraocular pressure (IOP), pre and postoperative glaucoma medications, peri and postoperative complications and interventions, and incidence of repeat corneal transplantation and additional glaucoma procedures to control IOP.Results: Fourteen eyes with previous cornea transplantation underwent XEN stent implantation. Mean age was 70.1 years (range: 47-85 y). Mean follow-up was 18.2 months (range: 1.5-52 mo). The most common glaucoma diagnosis was secondary open angle glaucoma (50.0%). There was a significant reduction in IOP and the number of glaucoma agents at all postoperative time points (P < 0.05). IOP decreased from 32.7 ± 10.0 mm Hg at baseline to 12.5 ± 4.7 mm Hg at the most recent follow-up. Glaucoma agents decreased from 4.0 ± 0.7 to 0.4 ± 1.0. Two eyes required additional glaucoma surgery to control IOP, with an average time to reoperation of 7 weeks. Two eyes underwent repeat corneal transplantation, with an average time to reoperation of 23.5 months. Conclusions:In selected patients with previous corneal transplants and refractory glaucoma, the XEN stent was safely implanted and effectively reduced IOP in the short term.

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Three-Year Findings of the HORIZON Trial

Cited by 53 publications

References 25 publications

Cost Utility of Schlemm’s Canal Microstent Injection With Cataract Surgery for Open-angle Glaucoma in the US Medicare System

Cost Utility of Schlemm’s Canal Microstent Injection With Cataract Surgery for Open-angle Glaucoma in the US Medicare System

Clinical and Visual Field Outcomes Following Minimally Invasive Glaucoma Surgery Combined with Cataract Surgery

Outcomes of XEN Stent in Patients With Glaucoma and Previous Corneal Transplantation

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