Novel device safely reduces IOP and glaucoma medication use

Take-home message: One-year after implantation of the Cypass Micro-Stent, study results demonstrate a reduction in IOP and glaucoma medications, as well as a complete lack of sight-threatening adverse events. The implant is placed into the supraciliary space to facilitate suprachoroidal aqueous outflow in glaucoma patients.

 

By Dr Magda Rau

Topical medication is the primary treatment option for open angle glaucoma. However, such an approach requires lifelong dependence on self-administered therapy.

Almost 50% of glaucoma patients require multiple intraocular pressure (IOP)-lowering medications for adequate pressure control and this polypharmacy often presents numerous challenges for patients.^1,2 Varied dosing regimens and compound side effects can decrease patient compliance^3,4 and additionally, chronic ocular surface problems are more common when multiple topical medications are prescribed.⁵ In some cases, the maximal possible medication is not capable of effective pressure reduction, even with good compliance.

Editorial: Should high-volume surgeons have surgical privileges?

The most common surgical option for lowering IOP is a guarded full- or partial-thickness filtration procedure such as trabeculectomy. However, conducting such a procedure introduces the risks of hypotony, hyphema, bleb leakage, bleb infection, and endophthalmitis. Indeed, complications may be experienced in more than 35% of filtration cases.⁶ As a result, filtering surgery is often reserved only for severe cases of progressive glaucoma.⁷

Experimental evidence suggests that increasing non-trabecular, uveoscleral outflow is a desirable approach to lowering IOP in patients with glaucoma. There is a negative pressure gradient between the suprachoroidal space and the anterior chamber that may provide a driving force for such aqueous outflow.⁸ In some areas the pressure difference can exceed 3–4 mmHg, with a gradient that increases along the posterior aspect of the suprachoroidal space. Clinical experience demonstrates that traumatic or iatrogenic cyclodialysis results in significant IOP reduction by creating additional non-trabecular outflow through the uveoscleral route.^9,10

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