Second non-implant MIGS shows efficacy if trabecular bypass stent does not control IOP
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A second non-implant MIGS intervention, namely canaloplasty and trabeculotomy, allows patients to achieve good IOP control if a prior trabecular micro-bypass stent has failed to maintain IOP as desired.
A multicenter retrospective study conducted at five U.S. centers analyzed the outcomes of 27 patients treated with a trabecular micro-bypass stent (iStent or iStent inject, Glaukos) and subsequently with the Omni surgical system (Sight Sciences) due to inadequate pressure control.
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Mean IOP decreased from 22.3 mm Hg at baseline to 17.1 mm Hg at 3 months and 17.2 mm Hg at last follow-up; 85% of patients had IOP below 21 mm Hg at last follow-up, and 56% had IOP of 18 mm Hg or lower.
Medications decreased from an average of 2.2 at baseline to 1.2 at 3 months and 1.8 at last follow-up; 81.5% of patients were on the same number of medication or fewer at last follow-up, and 30% were completely off medications. The Omni procedure was well tolerated, and adverse events were mostly nonserious, transient and self-resolving.
MIGS is an increasingly widespread intervention for mild to moderate glaucoma when patients are inadequately controlled on IOP-lowering drops or have tolerance or adherence issues, the authors said. Trabecular micro-bypass stents are commonly used as a first procedure and can successfully treat many patients. However, when the first MIGS fails, treatment escalation does not preclude a second MIGS, as shown by this study. According to the authors, this second intervention might be preferable over the addition of other medications, which may lead to diminished efficacy, increased side effects and compliance issues.
“We believe that additional study of the [Omni surgical system] in this population is warranted and look forward to confirmation of our results in additional studies by other investigators,” the authors said.
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