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Trabecular bypass stents changing glaucoma practice
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VANCOUVER, British Columbia — As experience grows with minimally invasive glaucoma surgery, the paradigm of glaucoma treatment is changing, according to a speaker here.
“The place for MIGS is perhaps after laser treatment. Perhaps it’s even before laser treatment,” Paul Harasymowycz, MD, FRCSC, said at the World Glaucoma Congress. Furthermore, a combined MIGS and cataract procedure can be done as the primary procedure in patients with both glaucoma and cataracts, he said.
In Canada, where the trabecular bypass iStent (Glaukos) has been available for more than 3 years, surgeons often use two iStents in one patient, he said.
“The reason for putting in two is … to lower the pressure more,” he said, adding that fewer medications are needed, as well.
Another device that is currently under investigational use in the U.S. is the Hydrus micro-stent (Ivantis), which dilates Schlemm’s canal without obstructing the collectors, he said.
“Trabecular bypass stents are definitely a game-changer in our practices,” Harasymowycz said. “For those who are not doing it, you will be doing it.”
Harasymowycz suggested initially targeting patients whose IOP is well controlled on multiple medications and later, as comfort with the technique increases, offering trabecular bypass stents to patients with moderate to more advanced glaucoma.
The MIGS stents decrease burden of drops, provide excellent safety profiles, provide quicker visual recovery and better visual acuity, and even though expensive, they may be cost-effective if fewer visits and fewer interventions are needed, Harasymowycz said.
Disclosure: Harasyowycz has received speaking honoraria from Alcon and AMO, is a consultant for SOLX and has performed research with Ivantis.