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    Drug delivery systems could improve poor adherence



    Rather than a biodegradable device, Glaukos, maker of the iStent microinvasive glaucoma surgery device, is testing a titanium implant (iDose) measuring 1.8 mm by 0.5 mm that embeds itself in the sclera with a barbed anchor and releases concentrated travoprost at a rate controlled by a membrane.

    The implantation procedure is more involved than with the other two devices, said Dr. Myers.

    "It's more than injecting a pellet of drug,” Dr. Myers said. “It requires viewing the angle with a gonio prism and the surgeon placing this in the right place."

    Still, the treatment appears promising and more straightforward than many angle-based surgeries.

    In a trial planned to last 3 years, 154 subjects were divided into 3 groups: a fast-eluting implant with placebo drops, a slow-eluting implant with placebo drops, and sham surgery with timolol drops twice a day.

    In the first 9 months of data, which Glaukos shared with Dr. Myers, patients achieved a 8.3 mm Hg reduction in IOP with the fast-eluting device, 7.9 mm Hg reduction with the slow-eluting device and 7.6 mm Hg reduction with timolol drops.

    Adverse events included increased IOP (2.6%), iritis (2.6%), decreased visual acuity of at least 2 lines (2.6%), dry eye (1.9%), inflammation (1.9%), eye pain (1.9%), conjunctivitis (1.3%), foreign body sensation (1.3%), and posterior vitreal detachment (1.3%).

    Almost all the patients stayed in the trial for at least 3 months, but only about half remained after 9 months. "Still for that half, you get 9 months with a single procedure," Dr. Myers added.

    "Multiple systems could come to market," Dr. Myers said. "All look like they have relatively good safety and efficacy."

    Jonathan S. Myers, MD 

    p. (215-928-3197

    e. [email protected]

    This article was adapted from a presentation that Dr. Myers delivered at the Glaucoma Subspecialty Day held prior to the 2017 American Academy of Ophthalmology meeting. Dr. Myers is a consultant/speaker for Allergan and Glaukos, and he receives research grants from Allergan.

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