Advancements should take glaucoma surgery to the next level
Click Here to Manage Email Alerts
Key takeaways:
- Marlene R. Moster, MD, discusses four new glaucoma surgery innovations.
- Motivation and collaboration should lead to better outcomes with fewer complications.
SAN DIEGO — Upcoming surgical innovations may help take the treatment of glaucoma to the next level, according to a lecturer here.
“I want to share with you what is coming down the pike, what advances that will raise the bar that will help us get to the next level,” Marlene R. Moster, MD, said during the Richard L. Lindstrom, MD, Lecture at the American Society of Cataract and Refractive Surgery meeting.
To deal with the issue of patient compliance, a new concept involves a drug-based delivery system that combines cataract surgery and glaucoma medication for a long duration of action. In the SpyGlass drug delivery platform, dual pads of drugs secured to the haptics of an acrylic IOL slowly elute medication over a 3-year period after phacoemulsification.
“This data has been validated both in vivo and in vitro, and if and when approved, this new drug-based delivery system will be accessible to all ophthalmologists, including the 75% of cataract surgeons who are currently not utilizing MIGS,” Moster said.
Another problem is IOP fluctuation over time and the need to monitor a patient’s pressure at any time of the day or night.
“One possible example of a solution is a surgically placed intraocular pressure sensor capable of 24/7 pressure readings with reliable accuracy,” she said.
A 4-mm sensor from Injectsense is placed in the eye during a 5-minute office procedure. It can be recharged once a week and can last for decades. The physician can retrieve IOP data through the cloud to modify treatment at any time.
Implandata already has a CE mark for a micro-sensor that measures pressure and is placed within the suprachoroidal space during cataract surgery, glaucoma surgery or a stand-alone procedure. The patient can check IOP with a remote at any time, and the remote, which recharges the sensor, downloads the IOP data to a cloud-based platform to allow the physician to modify treatment as needed.
The third area that needs improvement is goniotomy, which is often performed with cataract surgery.
The T-Rex Duo from Iantrek opens the inner wall of Schlemm’s canal by blunt 360° excision and scrapes and opens the back wall for better access to the collector channels, maximizing flow when both walls are open. A robotic arm connected to the device may improve precision to 1 µm.
“This precise access to the canal will allow cataract surgeons to do a better job with the hardware to access Schlemm’s canal with greater precision, so both walls can be opened simultaneously,” Moster said.
Finally, Moster discussed elevating tube shunts to the next level.
“One possible solution is to change what the tube shunts are made of, change the material,” she said. “The second is to make them a lot thinner than we’re using right now.”
The VisiPlate (Avisi Technologies) is an ultrathin 5 µm thick shunt designed to avoid occlusion and to lower pressure below 14 mm Hg without causing hypotony. It is covered with a nonfibrotic material that restricts cell adhesions and has multiple outflow channels to cause a low, diffuse subconjunctival bleb.
“The VisiPlate is very strong. You can twist it, you can turn it, and it will not crack,” Moster said. “It is the thinnest freestanding material in the world thus far. It also allows for manipulations with our existing surgical tools, and it will not break.”
Another new tube is the Gore GDI concept. It is made of a material called ePTFE and is 10 times thinner than an Ahmed tube shunt. It is designed for rapid tissue ingrowth over the top, but cells cannot go into the reservoir.
“Therefore, it is very permeable to aqueous, which is just what we are looking for,” she said.
“Motivation from ophthalmologists and collaboration with scientists and engineers will give better outcomes for all with fewer complications,” Moster said. “I am totally convinced that with the research and innovation coming down the road, we will win.”
Collapse
Moster MR. Glaucoma surgery: Taking it to the next level. Presented at: American Society of Cataract and Refractive Surgery meeting; May 5-8, 2023; San Diego.
Click Here to Manage Email Alerts