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    Early surgical intervention with stent advantageous for certain glaucomas

    Approach may help physicians, patients avoid compliance, other medical therapy issues

     

    Conclusion

    The stent has changed the entire glaucoma treatment paradigm—treating glaucoma patients medically until they have nearly lost fixation is no longer acceptable to patients. Clinicians are more commonly approaching glaucoma as a surgical disease.

    Although topical medications and laser therapy will certainly continue to have roles in the treatment of glaucoma, the stent makes early surgical intervention appealing to both patients and surgeons. In select patients with early glaucoma and visually significant cataract, utilizing the stent as a first-line therapy is not only a viable option, but potentially the preferred treatment.

    Once the stent inject is approved as a stand-alone therapy, I suspect the role of this proven approach will continue to expand within patients with early glaucoma, thereby preventing the need for filtration surgery, such as trabeculectomy or tube shunt surgery, during a patient’s lifetime.

     

    Steven D. Vold, MD

    E: [email protected]

    Dr. Vold is founder of Vold Vision in Fayetteville and Bentonville, AR. Dr. Vold is a consultant to Glaukos.

     

    References

    1. Okeke CO, Quigley HA, Jampel HD, et al. Adherence with topical glaucoma medication monitored electronically the Travatan Dosing Aid study. Ophthalmology. 2009;116:191-199.

    2. Kent C. Glaucoma Drugs: The search for new options. 16 March 2007. Review of Ophthalmology. Available at: https://www.reviewofophthalmology.com/article/glaucoma-drugs-the-search-...

    3. Samuelson TW, Katz LJ, Wells JM, Duh Y-J, Giamporcaro JE. Randomized evaluation of the trabecular micro-bypass stent with phacoemulsification in patients with glaucoma and cataract. Ophthalmology. 2011;118:459-467. doi: 10.1016/j.ophtha.2010.07.007.

    4. Fea AM. Phacoemulsification versus phacoemulsification with micro-bypass stent implantation in primary open-angle glaucoma. J Cataract Refract Surg. 2010;36:407-412. doi: 10.1016/j.jcrs.2009.10.031.

    5. Craven ER, Katz LJ, Wells JM, Giamporcaro JE, for the iStent Study Group Cataract surgery with trabecular micro-bypass stent implantation in patients with mild-to-moderate open-angle glaucoma and cataract: Two-year follow-up. J Cataract Refract Surg. 2012;38:1339-1345. doi: 10.1016/j.jcrs.2012.03.025.

    6. Fea AM, Pignata, G, Bartoli E, et al. Prospective, randomized, double-masked trial of trabecular bypass stent and cataract surgery vs. cataract surgery alone in primary OAG: long-term data. Presented at the 2012 European Society of Cataract and Refractive Surgeons, Milan, Italy, September 2012.

    7. Arriola-Villalobos P, Martínez-de-la-Casa JM, Díaz-Valle D, et al. Combined iStent trabecular micro-bypass stent implantation and phacoemulsification for coexistent open-angle glaucoma and cataract: a long-term study. Br J Ophthalmol. 2012;96:645-649.

    8. Neuhann T. Trabecular micro-bypass stent implantation during small-incision cataract surgery for open-angle glaucoma or ocular hypertension: Long-term results. J Cataract Refract Surg. 2015;41:
    2664-2671.

    9. Lütjen-Drecoll E, Rohen JW. Functional morphology of the trabecular meshwork. In: Bilyk J, Tasman W, Jaeger EA, editors. Duane’s Foundations of Clinical Ophthalmology on CD-ROM. Vol. 1. Lippincott Williams & Wilkins, Vol; Philadelphia: 2006. pp. 1-28. Section 1, Ocular Anatomy, Embryology, and Teratology.

    10. Lütjen-Drecoll E, Shimizu T. Rohrbach M, Rohen JW: Quantitative analysis of “plaque material” in the inner and outer wall of Schlemm’s canal in normal and glaucomatous eyes. Exp Eye Res. 1986;42:443-455.

    11. Gabelt BT, Kaufman PL. Changes in aqueous humor dynamics with age and glaucoma. Prog Retin Eye Res. 2005;24:612-637.

    12. Tian B, Geiger B, Epstein DL, Kaufman PL. Cytoskeletal involvement in the regulation of aqueous humor outflow. Invest Ophthalmol Vis Sci. 2000;41:619-623.

    13. Gabelt BT, Gottanka J, Lütjen-Drecoll E, Kaufman PL. Aqueous humor dynamics and trabecular meshwork and anterior ciliary muscle morphologic changes with age in rhesus monkeys. Invest Ophthalmol Vis Sci. 2003;44:2118-2125.

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