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Complications associated with filtering procedures fuel surge in new surgical techniques
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DANA POINT, Calif. — There has been a surge in new technologies for the surgical management of glaucoma, according to a surgeon speaking here.
Traditional filtering surgeries are fraught with numerous short- and long-term complications, Sameh Mosaed, MD, told attendees at the Ocular Drug and Surgical Therapy Update.
"Traditional filtering procedures come with an approximate 20% early failure rate," Dr. Mosaed said. "We are always looking forward to our newer procedures and technologies that will help improve our patient outcomes."
There are many devices and technologies in various stages of use and development, she said.
"Some of these newer devices attempt to target the eye's natural physiologic outflow pathways," Dr. Mosaed said. "Others attempt to shunt aqueous via alternate pathways, while others still attempt to modulate aqueous production."
Dr. Mosaed focused on one of these new devices, the Trabectome (NeoMedix), which is a trabecular bypass device.
The Trabectome was approved by the U.S. Food and Drug Administration to treat adult and juvenile glaucoma. It allows direct access of the aqueous into the canal and the aqueous collector channels further downstream, she said.
"The mechanistic principle is similar to goniotomy or trabeculotomy, but the key difference is this device actually ablates the trabecular meshwork," Dr. Mosaed said. "The removal of the trabecular meshwork minimizes the potential for fibrosis and closure of the opening to Schlemm's canal."
Dr. Mosaed and colleagues have performed open-angle glaucoma treatment with the Trabectome in more than 200 patients, including pediatric patients, since it was approved in the United States in January 2006.
This trabeculectomy procedure has not been associated with shallow anterior postop chambers, hypotony, infection, cataract progression, wound leakage, bleb formation, choroidal effusion or visual acuity decrease, she said. However, some of the complications related to this procedure include transient hyphema, which resolves within 1 week, corneal epithelial defects, which are common in diabetic patients, and postoperative IOP spikes.
About half of all patients who underwent this procedure require at least one postoperative glaucoma medication to control IOP, Dr. Mosaed said.
"Preliminary results suggest this is a promising novel procedure, but additional experience is required to better define long-term outcomes," she said.