Refractory open-angle glaucoma treated with two trabecular micro-bypass stents,one suprachoroidal stent and prostaglandin

Session Details

Session Title: Glaucoma II

Session Date/Time: Tuesday 08/09/2015 | 08:00-10:30

Paper Time: 08:18

Venue: Room 17

First Author: : A.Jünemann GERMANY

Co Author(s): :    M. Group                    

Abstract Details

Purpose:

Micro-invasive glaucoma surgery (MIGS) using trabecular bypass stents has been demonstrated as a titratable therapy for intraocular pressure (IOP) control to ≤ 15 mmHg in open angle glaucoma (OAG). While such therapy aims to restore natural physiologic outflow, suprachoroidal stents can employ the uveoscleral outflow pathway to improve aqueous outflow. Combined use of both modalities may be considered for IOP reduction to < 15 mmHg when needed, e.g., in refractory OAG. The MIGS Study Group aimed to evaluate IOP lowering in refractory OAG subjects via treatment with two trabecular bypass stents, one suprachoroidal stent and postoperatively prescribed travoprost.

Setting:

A total of 36 visiting surgeons and staff surgeons from nine countries worldwide comprise the MIGS Study Group. The S.V. Malayan Ophthalmological Center in Yerevan, Armenia is the investigational site at which surgeries have been performed for this and the other MIGS studies.

Methods:

In this prospective study, we enrolled 80 phakic or pseudophakic patients with OAG previously not controlled following treatment with trabeculectomy and medications. Subjects were required to have preoperative IOP between 18 mmHg and 45 mmHg on medication, and IOP between 21 mmHg and 45 mmHg following medication washout. Subjects then underwent implantation of two iStents (Glaukos) and one iStent supra (Glaukos). Postoperatively, all subjects were prescribed Travoprost. IOP, medication use, slit-lamp and optic nerve evaluation, BCVA and adverse events are evaluated through five years postoperative. Sixty-eight subjects have been followed through 25 months postoperative.

Results:

Mean medicated preoperative IOP was 22.0 mmHg (SD 3.1) and 26.4 mmHg (SD 2.4) following medication washout. Mean medicated IOP decreased to 13.7 mmHg or less at all postoperative time periods through Month 24. Following a 1-month medication washout, mean IOP at Month 25 ws 17.0 (SD 1.5). Four subjects required additional medication. One subject had 2 iStents implanted only due to poor visibility. All other subjects underwent uncomplicated implantation of two iStents and one iStent supra. Cataract progression with BCVA loss ≥ 1 line over 2 years occurred in 8 eyes, with 1 eye requiring cataract surgery.

Conclusions:

This series to treat subjects with refractory OAG with 2 trabecular bypass stents, 1 suprachoroidal stent and 1 postoperative medication showed a sustained management of IOP to < 15 mmHg, reduced drug burden, and a low rate of adverse events through 2 years postoperatively. These results contribute to the evidence showing the synergistic use of trabecular bypass and suprachoroidal stents for management of refractory OAG.

Financial Interest:

NONE