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MIGS treatment reduces medication use, IOP
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The use of a single trabecular microbypass stent provided a sustained reduction in IOP in patients that presented with mild to severe open-angle glaucoma, an effect that became more robust as baseline IOP increased, according to a study published in the Journal of Cataract & Refractive Surgery.
This is a continuation of a previous study, also led by Tanner Ferguson, MD, which studied the efficacy of a trabecular microbypass stent in patients with open-angle glaucoma (OAG) with 24 months of follow up.
“Because of the risks associated with traditional filtering procedures and the adverse effects associated with topical therapies, microinvasive glaucoma surgery (MIGS) procedures have emerged as safe and effective options for patients with primary and secondary OAG,” the authors wrote. “Notable advantages of MIGS procedures are their safety and flexibility; moreover, they preserve the option for future surgery and can be combined with other MIGS procedures.”
In this retrospective consecutive case series, researchers studied pseudophakic eyes of 40 patients with mild to severe OAG with one trabecular microbypass stent implanted. Collecting data at baseline, 1 day, 1 week, 1 month and up to 48 months postop, collaborators measured patients’ number of glaucoma medications, IOP and whether a secondary surgery was necessary.
From baseline to 48 months postop, researchers found that IOP was reduced by a mean of 23%. In addition, they reported no postoperative or intraoperative complications. Patients previously taking ocular hypotensive medication with an IOP of 18mm Hg or higher saw a statistically significant reduction in both medication use and IOP.
“Based on the stratification of glaucoma severity and baseline characteristics, the findings of this study suggest the stent is a particularly safe and efficacious treatment option for mild to moderate pseudophakic OAG eyes with a higher baseline IOP (eg, 18 mm Hg),” the authors wrote. “Although it is retrospective in nature, this study conveys insight on the long-term safety and efficacy of the device as a standalone procedure and the IOP-lowering ability of the stent independent of phacoemulsification.” – by Scott Buzby
Disclosures: Ibach, Schweitzer and Berdahl are speakers and consultants to Glaukos Corp. Ferguson is a consultant to Glaukos Corp. None of the other authors reported any relevant financial disclosures.
Perspective
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Lisa M. Young, OD, FAAO
MIGS have changed the way we approach the earlier stages of glaucoma and are deservingly a hot topic in our field. We are developing new procedures and re-examining the current options, striving to find a procedure that effectively lowers IOP in a safe and relatively noninvasive way. The first MIGS device to enjoy widespread use was the iStent trabecular microbypass stent (Glaukos), which received FDA approval to be performed in conjunction with cataract surgery back in 2012.
Through this retrospective case review, Ferguson and colleagues demonstrate that iStent implantation in pseudophakic eyes can be a safe and efficacious treatment option for patients with mild to moderate OAG. Considering that cataract surgery lowers IOP, it’s good to know that this device is efficacious as a stand-alone procedure. Also, they found that the results persisted for 48 months. However, most are now moving to the iStent Inject device, which was FDA approved last year, and other MIGS approaches are showing more promise.
The iStent has had a good run, but I’ve been underwhelmed by its IOP-lowering ability. Although I’m sold on the MIGS approach, newer and more efficacious devices will surely replace it. The search continues …
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