Procedural Pharmaceuticals in Glaucoma: Focus on Bimatoprost and Travoprost Implants

EP: 1.Interventional Approaches to Lower IOP and Minimize Medication Use

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EP: 2.Procedural Pharmaceuticals in Glaucoma: Focus on Bimatoprost and Travoprost Implants

EP: 3.Surgical Considerations for Implanting Travoprost Intracameral Implant (iDose)

In this segment, the panelist focuses on the role of procedural pharmaceuticals in glaucoma management and the importance of selecting the right patients for these treatments. Two primary drug delivery options currently available in the US are highlighted: the bimatoprost sustained-release implant (Durysta) and the travoprost intracameral implant (iDose). Although both serve as alternatives to daily topical medications, they differ in their design, delivery methods, and ideal patient profiles, making it essential for clinicians to understand when and how to best utilize them in practice.

The discussion then centers on the Durysta implant, a biodegradable intracameral device that slowly breaks down into lactic and glycolic acid while releasing bimatoprost. The implant is delivered through a clear corneal microinjection with a fine needle, allowing it to settle in the inferior angle of the anterior chamber. The procedure is minimally invasive, straightforward, and can be performed either at the slit lamp in the office or in an ambulatory surgery center. Once placed, the implant continuously releases medication over about 4 months, providing a significant advantage for patients who may struggle with adherence to daily eye drops.

What makes the Durysta implant particularly noteworthy is its long-term efficacy. Recent clinical data, including phase 3b and phase 4 trials, demonstrate that nearly 78% of patients maintained therapeutic benefit for up to 18 months following a single implant. This durability reduces the frequency of interventions and addresses challenges related to adherence, cost, and ocular surface issues associated with topical therapies. By extending the effectiveness of treatment well beyond the expected 4-month release period, procedural pharmaceuticals like Durysta present a promising approach for improving patient outcomes in glaucoma care.