This article is more than 5 years old. Information may no longer be current.
Few adverse events seen with Micro-Stent in open-angle glaucoma
Click Here to Manage Email Alerts
Few ocular adverse events occurred 5 years after micro-stent implantation in patients with open-angle glaucoma, with minimal evidence of corneal decompensation, according to findings published in the American Journal of Ophthalmology.
George Reiss, MD, and colleagues sought to characterize the long-term safety and effectiveness of the supraciliary Micro-Stent (Alcon) implanted at the time of phacoemulsification in eyes with coexisting open-angle glaucoma and visually significant cataract.
“[Minimally invasive glaucoma surgery] MIGS procedures have altered the therapeutic landscape for primary open-angle glaucoma,” Reiss, a glaucoma specialist from the Eye Physicians and Surgeons of Arizona, and colleagues wrote. “The advent of MIGS has positioned surgery earlier in the paradigm than conventional surgery, and when MIGS is combined with cataract surgery, it can reduce IOP, or the IOP-lowering medication burden, or both.”
The researchers evaluated data of patients from the COMPASS trial who received either Micro-Stent plus phacoemulsification (n = 215) or solely phacoemulsification (n = 67), evaluated at 3 to 5 years postoperatively. The primary outcome was the occurrence of sight-threatening ocular adverse events.
Evaluation at each time point included best-corrected visual acuity, anterior and posterior segment examination, tonometry, gonioscopy, pachymetry, perimetry, specular microscopy and adverse event assessment, Reiss and colleagues wrote.
The researchers found three sight-threatening ocular adverse events occurred, two in the micro-stent group and one in the phacoemulsification alone group, with no relation to the Micro-Stent. Ocular adverse events occurred at the same frequency in both groups, with BCVA loss of two or more lines compared with best BCVA in COMPASS and worsening visual field mean defect 2.5 decibels or greater after 2 years.
After 5 years, a higher proportion of patients in the Micro-Stent group were able to achieve a reduction of 20% of IOP without the use of hypotensive medicine (46%) compared with the control group (32.1%). – by Earl Holland Jr.
Disclosures: The authors report no relevant financial disclosures.
Perspective
Back to Top
Carl H. Jacobsen, OD, FAAO
MIGS has been a welcome addition to our glaucoma treatment regimen. These procedures and devices should help reduce the need for more invasive and potentially dangerous filtering procedures. It’s still early in their development, and there have been bumps in the development road; iStent (Glaukos) underwhelms, CyPass (Alcon) was recalled, and Xen (Allergan) may not be as effective or easy to manage as initially thought. The procedures (gonioscopy-assisted transluminal trabeculotomy, Kahook Dual Blade by New World Medical, Trabectome by NeoMedix) are technically more difficult, and efficacy hasn’t been sufficiently well established. Do MIGS work and are they safe?
Reiss and colleagues provide 5-year results of CyPass Micro-Stent data from their randomized clinical trial. Despite the recall for risk of endothelial cell loss, the authors present encouraging safety data. So, a device recalled for safety issues may, in fact, be safe to use? Alcon is in discussion with regulatory authorities about the future of CyPass. These data should reassure your patients who have undergone implantation.
I’ve been treating glaucoma for 25+ years. Procedures come and go and at the end of the day we have drugs, laser and invasive filtering surgery. MIGS are different; I think they are here to stay; but I’m still waiting for a device or procedure to really come to the fore. Stay tuned.
Read more about
Click Here to Manage Email Alerts