Miniject supraciliary drainage device safe, effective for mild to moderate glaucoma
Key takeaways:
- Nearly 90% of participants achieved a reduction in IOP of 20% or greater.
- Endothelial cell density loss was less than 30% for all participants.
The supraciliary drainage implant Miniject can safely and effectively treat mild to moderate glaucoma as a standalone procedure, according to a study published in the American Journal of Ophthalmology.
“The outcomes of this meta-analysis, which assessed the Miniject supraciliary glaucoma drainage implant up to 2 years after implantation in a standalone procedure, confirm the favorable performance and safety profile of Miniject,” H. Burkhard Dick, MD, PhD, from University Eye Hospital in Bochum, Germany, and colleagues wrote.
Miniject (iStar Medical) is a silicone, microporous drainage device with 27µm hollow sphere geometry that enables fluid to flow through the length of the 5 mm device.
Dick and colleagues conducted a meta-analysis of 82 individuals with primary open-angle glaucoma who participated in three prospective, non-randomized trials across 11 sites in Colombia, France, Germany, India, Panama and Spain. The researchers gathered data of up to 2 years follow-up after implantation of the device.
According to results, mean IOP was reduced from 23.8 mm Hg at baseline to 14.4 mm Hg at 2 years. Further, 89.4% of participants achieved a reduction in IOP of at least 20% and 37.9% of participants were medication-free at 2 years. No participant experienced an endothelial cell density loss that exceeded 30%.
The most frequent adverse events were anterior chamber inflammation, reduced visual acuity, hyphemia and conjunctival hemorrhage.
“Miniject can be considered a valuable surgical treatment option for mild to moderate glaucoma patients, and an effective alternative to other MIGS up to 2 years after implantation,” Dick and colleagues wrote.
Perspective
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Microinvasive glaucoma surgeries have changed the way we approach early to moderate stages of glaucoma and continue to evolve. These ab-interno procedures strive to lower IOP through a “minimally” invasive approach, allowing for faster recovery, fewer postoperative complications, minimal impact on refractive error and preservation of the conjunctival tissue, should incisional surgery be warranted in the future.
The majority of these procedures lower IOP by targeting the conventional pathway of aqueous outflow via the trabecular meshwork, while the Miniject targets the uveoscleral outflow pathway via the suprachoroidal space. The meta-analysis of this device by Dick and colleagues has promising results.
The first device to take the supraciliary approach was the CyPass Micro-Stent (Alcon), which also had favorable results but was ultimately withdrawn from the market in 2018 secondary to concerns of long-term endothelial cell density loss.
Based on the safety and efficacy profile of Miniject, I’m optimistic that the implant may finally bring us outcomes we have been searching for. But as has been the case with MIGS, time will be the ultimate judge.
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