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New glaucoma implants, techniques safely reduce IOP, medication use

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Emerging and evolving techniques and devices promise to enhance the safety and efficacy of combined cataract and glaucoma surgery, a speaker said.

"We should be able to differentiate glaucoma devices," Ocular Surgery News Glaucoma Board Member Richard A. Lewis, MD, told colleagues at Hawaiian Eye 2011. "What's most important is the ease of the procedure and the reduction of complications."

One new device, the Hydrus Aqueous Implant (Ivantis), a flexible, biocompatible canal scaffold, features multiple collector channels when implanted in nasal quadrants. The device is approved for clinical investigational use only and is not commercially available in the United States, Dr. Lewis said.

The iStent (Glaukos) is designed to lower IOP while reducing or eliminating medication use. In the U.S. Food and Drug Administration IDE trial comparing cataract surgery alone vs. cataract surgery plus iStent, 12-month data showed that 73% of iStent patients had IOP of 21 mm Hg or lower without medication, compared with 50% of patients who underwent cataract surgery alone, Dr. Lewis said. The difference was statistically significant (P < .001). The FDA has not approved the device for commercial use.

Canaloplasty, indicated for open-angle glaucoma, has also shown promising results. According to a study, combined canaloplasty and cataract surgery yielded a mean IOP of 14 mm Hg with 0.2 medications at 24 months. Fewer than one in six patients required IOP-controlling medication after combined surgery, Dr. Lewis said.

The Trabectome (NeoMedix) provides continuous cooling flow, aspirates debris, ablates a strip of trabecular meshwork and limits incision depth.

The iStent has yielded fewer complications and offered greater ease of use than trabeculectomy, Trabectome and canaloplasty, Dr. Lewis said.

• Disclosure: Dr. Lewis is a consultant for Aerie, Alcon, Allergan, AqueSys, Astellas, iScience Interventional, Ivantis, Pfizer, QLT, Santen, Transcend and TrueVision.

Hawaiian Eye and Retina 2012 will be held January 15-20 at the Grand Wailea Resort & Spa in Maui. Learn more at OSNHawaiianEye.com or RetinaMeeting.com.