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    Single-use MIGS device demonstrates significant reduction in IOP in retrospective study

    Study compared two minimally invasive ab interno trabecular meshwork/canal-based procedures



    Retrospective study results


    A recent study compared the IOP-lowering effects of cataract extraction (CE) with the titanium stent (iStent) versus CE with ab interno trabeculectomy using a dual blade device (KDB) in patients with mild-to-moderate glaucoma. The study took place at 12 sites (11 in the United States and one in Mexico) and evaluated both postoperative IOP and medication use in 435 eyes treated either by CE+blade (n = 198) or CE+stent (n = 237). Both groups had similar baseline demographics.


    Mean postoperative IOP in the excision blade group was lower when compared with the stent throughout the study follow up period (Table 1). At six months, the reduction in mean IOP was 23.7% and 16.4% for the blade and stent groups, respectively (p < 0.05) (Figure 3).


    The blade group also exhibited significant reduction in medication use up to 6 months (Figure 4).


    While the mean number of medications at 1 day and 1 week postoperatively were similar between the groups, the blade arm began to show a statistically significant reduction in medication use at month 1 compared with the stent arm (64.6% versus 44.6%, respectively; p < 0.05). This difference was sustained through month 6 with a 62.9% reduction in the KDB group (1.7 to 0.6 medications) compared with 46.1% in the iStent group (1.9 to 1.0 medications) (p < 0.05).


    Adverse events in both the KDB and iStent groups were comparable, mild and self-limiting (Table 2).


    As is expected with canal-based glaucoma procedures, varying degrees of intraoperative blood reflux from Schlemm’s canal was seen in both arms and was self-limited in all cases for both groups.


    In this study, the CE+blade produced significant results over 6 months in patients with uncontrolled mild-to-moderate glaucoma. This group exhibited meaningfully greater reductions in IOP and resulted in significantly less medication use when compared with CE+iStent.


    This study was retrospective and unrandomised, and therefore subject to bias. In future, prospective randomised clinical trials comparing different MIGS devices are necessary to better evaluate and individualise the MIGS decision pathway.


    In my daily practice, I routinely use the excision blade for patients with mild-to-end-stage glaucoma and have had success at treating glaucomatous eyes with follow-ups of over one year. I find ab interno trabeculectomy to be a valid option when trying to decrease medication burden.


    More recently, I have started using it in some refractory or advanced cases where I would prefer to avoid more invasive procedures. Preliminary (unpublished) results from this group are promising.


    While longer-term data are still needed, the blade procedure offers surgeons an elegant and simple way to lower IOP by excising TM. This intuitive device offers many advantages to surgeons and patients and will continue to propel minimally invasive ab interno glaucoma procedures forward.


    We live in a golden age for glaucoma surgery, as intensive innovation of recent years is now translating into better patient outcomes.

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