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    Gel stent brings new hope for early glaucoma patients

    Device as effective as trabeculectomy, can be used early with less surgical side effects


    The outcomes of stand-alone implants and implants combined with cataract surgery were similar. At 12 months, stand-alone gel implants showed a mean drop of 47% from preoperative IOP, from 23.6 mm Hg preoperatively to 12.6 mm Hg postoperatively. That compares with a 40% mean drop for the combined cataract surgery plus gel stent, from 21.7 to 13.0. Outcomes for combined trabeculectomy and cataract surgery are typically worse than trabeculectomy alone.

    Overall intraoperative safety is also better than trabeculectomy, Dr. Reitsamer said.

    The most common adverse event, intraoperative subconjunctival or anterior chamber bleeding, was reported in just 1.2% of procedures. There were cataract-related complications not associated with the stent in 0.8% of procedures and lower rates of conjunctival perforation and iris damage.

    Should high-volume surgerons have surgical privileges?

    Postoperative adverse events were also low. Hyphema was the most common observation at 2.6%, followed by self-limiting choroidal effusion that lasted less than 30 days at 1%, shallow anterior chamber at 0.8%, viscoelastic injection into the anterior chamber at 0.6% and anterior chamber tap to release retained viscoelastic at 0.4%.

    Less common events included self-limiting choroidal effusion lasting more than 30 days, corneal abrasion, allergy to postoperative medication and unrelated events including systemic conditions, hospitalizations, and death.

    Safety was a particular interest because surgeons who perform superficial anterior lamellar keratoplasty routinely use the gel stent with very good results, Dr. Reitsamer said. The question was whether surgeons who may not have as much experience have similar outcomes.

    Next: "We should be doing more sugeries and earlier surgeries"

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