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Glaucoma implant shows encouraging long-term results
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Long-term, first results with the Eyepass glaucoma implant showed significant reduction of IOP, decreased use of medication and a favorable safety profile in a study.
The Eyepass (GMP Vision Solutions) is a Y-shaped bidirectional microsurgery implant that connects the Schlemm’s canal with the anterior chamber, bypassing the trabecular meshwork and directing the aqueous in two directions. In this study, it was implanted in 14 eyes of 13 patients, 10 of which completed the 5-year follow up, according to the study.
IOP was reduced from a mean 26.4mm Hg at baseline (range 13 mm Hg to 44 mm Hg) to 16.7 mm Hg at 1 year (range 10 mm Hg to 24 mm Hg) and 16.4 mm Hg at 5 years (range 10 mm Hg to 29 mm Hg). This represents a significant mean reduction of 30.3%. Medications were reduced from a mean of two at baseline after washout (range 0 to 4) to a mean of 0.9 at 5 years. Five patients (35.7%) were completely off medications.
Transient hypotony in the first week after surgery was the most common complication. Two eyes required a surgical revision due to malpositioning of the device. One eye required trabeculectomy after 16 months, and one eye required cyclophotocoagulation after 4 years. Cataract surgery was required in six eyes.
Unexpectedly, a filtering bleb formed in all eyes, although no bleb should be expected with the Eyepass device, the authors said. The blebs were sustained in some cases with the use of antimetabolites, and in one case bleb needling was performed after 7 months.
According to the authors, “bleb formation might occur as a transient finding in this nonpenetrating glaucoma surgery.” Their effect is probably negligible, and “intensified postoperative care for bleb formation is not necessary in this kind of surgery.” – by Michela Cimberle
Disclosure: The authors reported no financial disclosures
Perspective
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Scott Anthony, OD, FAAO
We are well into the microinvasive glaucoma surgical era, and the results are coming in as newer devices are being rolled out. This small study looked at the long-term intraocular pressure-lowering effect of the Eyepass shunt implant, which was shown to be effective.
Although touted as microinvasive, the surgical implantation of this device is anything but routine and should not be considered a "quick fix." Ophthalmologists continue to test a variety of glaucoma surgical devices and techniques to bridge patients from medical and trabeculoplasty therapies to trabeculectomy. Ideally, use of these devices will reduce or possibly eliminate the future need for traditional trabeculectomy or large shunts.
I think we are seeing a re-shuffling of the MIGS deck, where certain microinvasive glaucoma devices are edging out others based upon outcomes, complications and surgeon preference. Although this study showed Eyepass to be successful, other novel microinvasive glaucoma devices have likely already edged it out.
It’s still in the early days. Stay tuned to find out if MIGS take an instrumental role in glaucoma management and which particular device/devices come out on top.
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