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Open Access 01-12-2016 | Review

The New Era of Glaucoma Micro-stent Surgery

Authors: Demetrios T. Manasses, Leon Au

Published in: Ophthalmology and Therapy | Issue 2/2016

Abstract

Minimally invasive glaucoma surgery (MIGS) has been gaining popularity over the last decade. Although there is no strict definition for MIGS, all the new procedures share the common theme of intraocular pressure reduction with minimal tissue destruction, short surgical time, simple instrumentation and fast postoperative recovery. The use of glaucoma drainage implants has long been the traditional treatment for complex glaucoma, but a new wave of glaucoma micro-stents are now being manufactured with various materials designed to increase aqueous outflow via different channels. This review summarises the current published literature on these devices, including Sclemm’s canal stents (iStent, Hydrus), Suprachoroidal stents (CyPass, iStent supra), and subconjunctival stents (Xen, Innfocus).

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Craven ER, Katz LJ, Wells JM, Giamporcaro JE, 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(8):1339–45.CrossRefPubMed

Fea AM. Phacoemulsification versus phacoemulsification with micro-bypass stent implantation in primary open-angle glaucoma: randomized double-masked clinical trial. J Cataract Refract Surg. 2010;36(3):407–12.CrossRefPubMed

Fea AM, Consolandi G, Zola M, et al. Micro-bypass implantation for primary open-angle glaucoma combined with phacoemulsification: 4-year follow-up. J Ophthalmol. 2015;2015:795357.PubMedPubMedCentral

Arriola-Villalobos P, Martínez-de-la-Casa JM, Díaz-Valle D, et al. Mid-term evaluation of the new Glaukos iStent with phacoemulsification in coexistent open-angle glaucoma or ocular hypertension and cataract. Br J Ophthalmol. 2013;97(10):1250–5.CrossRefPubMed

Neuhann TH. 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(12):2664–71.CrossRefPubMed

Hann CR, Vercnocke AJ, Bentley MD, Jorgensen SM, Fautsch MP. Anatomic changes in Schlemm’s canal and collector channels in normal and primary open-angle glaucoma eyes using low and high perfusion pressures. Investig Opthalmol Vis Sci. 2014;55(9):5834.CrossRef

Bahler CK, Smedley GT, Zhou J, Johnson DH. Trabecular bypass stents decrease intraocular pressure in cultured human anterior segments. Am J Ophthalmol. 2004;138(6):988–94.CrossRefPubMed

Belovay GW, Naqi A, Chan BJ, Rateb M, Ahmed IIK. Using multiple trabecular micro-bypass stents in cataract patients to treat open-angle glaucoma. J Cataract Refract Surg. 2012;38(11):1911–7.CrossRefPubMed

10.

Katz LJ, Erb C, Carceller GA, et al. Prospective, randomized study of one, two, or three trabecular bypass stents in open-angle glaucoma subjects on topical hypotensive medication. Clin Ophthalmol Auckl NZ. 2015;9:2313–20.

11.

Bahler CK, Hann CR, Fjield T, Haffner D, Heitzmann H, Fautsch MP. Second-generation trabecular meshwork bypass stent (iStent inject) increases outflow facility in cultured human anterior segments. Am J Ophthalmol. 2012;153(6):1206–13.CrossRefPubMed

12.

Fea AM, Belda JI, Rękas M, et al. Prospective unmasked randomized evaluation of the iStent inject (^®) versus two ocular hypotensive agents in patients with primary open-angle glaucoma. Clin Ophthalmol Auckl NZ. 2014;8:875–82.

13.

Voskanyan L, García-Feijoó J, Belda JI, Fea A, Jünemann A, Baudouin C. Prospective, unmasked evaluation of the iStent^® inject system for open-angle glaucoma: synergy trial. Adv Ther. 2014;31(2):189–201.CrossRefPubMedPubMedCentral

14.

Hays CL, Gulati V, Fan S, Samuelson TW, Ahmed IIK, Toris CB. Improvement in outflow facility by two novel microinvasive glaucoma surgery implants. Invest Ophthalmol Vis Sci. 2014;55(3):1893–900.CrossRefPubMedPubMedCentral

15.

Camras LJ, Yuan F, Fan S, et al. A novel Schlemm’s Canal scaffold increases outflow facility in a human anterior segment perfusion model. Invest Ophthalmol Vis Sci. 2012;53(10):6115–21.CrossRefPubMed

16.

Pfeiffer N, Garcia-Feijoo J, Martinez-de-la-Casa JM, et al. A randomized trial of a Schlemm’s canal microstent with phacoemulsification for reducing intraocular pressure in open-angle glaucoma. Ophthalmology. 2015;122(7):1283–93.CrossRefPubMed

17.

Compare the Hydrus Microstent (TM) to the iStent for lowering IOP in glaucoma patients having cataract surgery (Hydrus III). https://clinicaltrials.gov/ct2/show/NCT02024464 [Internet].

18.

Comparing effectiveness of the hydrus microstent (TM) to two iStents to lower IOP in Phakic eyes (Hydrus V). https://clinicaltrials.gov/ct2/show/NCT02023242 [Internet].

19.

Weinreb RN, Toris CB, Gabelt BT, Lindsey JD, Kaufman PL. Effects of prostaglandins on the aqueous humor outflow pathways. Surv Ophthalmol. 2002;47(Suppl 1):S53–64.CrossRefPubMed

20.

Emi K, Pederson JE, Toris CB. Hydrostatic pressure of the suprachoroidal space. Invest Ophthalmol Vis Sci. 1989;30(2):233–8.PubMed

21.

Razeghinejad MR, Spaeth GL. A history of the surgical management of glaucoma. Optom Vis Sci. 2011;88(1):E39–47.CrossRefPubMed

22.

Hoeh H, Ahmed IIK, Grisanti S, et al. Early postoperative safety and surgical outcomes after implantation of a suprachoroidal micro-stent for the treatment of open-angle glaucoma concomitant with cataract surgery. J Cataract Refract Surg. 2013;39(3):431–7.CrossRefPubMed

23.

Höh H, Grisanti S, Grisanti S, Rau M, Ianchulev S. Two-year clinical experience with the CyPass micro-stent: safety and surgical outcomes of a novel supraciliary micro-stent. Klin Monatsblätter Für Augenheilkd. 2014;231(4):377–81.CrossRef

24.

Grisanti S, Margolina E, Hoeh H, et al. Supraciliary microstent for open-angle glaucoma: clinical results of a prospective multicenter study. Ophthalmol Z Dtsch Ophthalmol Ges. 2014;111(6):548–52.

25.

García-Feijoo J, Rau M, Grisanti S, et al. Supraciliary micro-stent implantation for open-angle glaucoma failing topical therapy: 1-year results of a Multicenter Study. Am J Ophthalmol. 2015;159(6):1075–1081.e1.CrossRefPubMed

26.

Yu D-Y, Morgan WH, Sun X, et al. The critical role of the conjunctiva in glaucoma filtration surgery. Prog Retin Eye Res. 2009;28(5):303–28.CrossRefPubMed

27.

Lewis RA. Ab interno approach to the subconjunctival space using a collagen glaucoma stent. J Cataract Refract Surg. 2014;40(8):1301–6.CrossRefPubMed

28.

Sheybani A, Reitsamer H, Ahmed IIK. Fluid dynamics of a novel micro-fistula implant for the surgical treatment of glaucoma. Invest Ophthalmol Vis Sci. 2015;56(8):4789–95.CrossRefPubMed

29.

Sheybani A, Lenzhofer M, Hohensinn M, Reitsamer H, Ahmed IIK. Phacoemulsification combined with a new ab interno gel stent to treat open-angle glaucoma: pilot study. J Cataract Refract Surg. 2015;41(9):1905–9.CrossRefPubMed

30.

Sheybani A, Dick B, Ahmed IIK. Early clinical results of a novel ab interno gel stent for the surgical treatment of open-angle glaucoma. J Glaucoma. 2015. doi:10.1097/IJG.0000000000000352

31.

Sheybani A, Ahmed IK. Ab interno gelatin stent with mitomycin-C combined with cataract surgery for treatment of open-angle glaucoma: 1-year results. In: Presented at ASCRS 2015.

32.

Pinchuk L, Wilson GJ, Barry JJ, Schoephoerster RT, Parel J-M, Kennedy JP. Medical applications of poly(styrene-block-isobutylene-block-styrene) (“SIBS”). Biomaterials. 2008;29(4):448–60.CrossRefPubMed

33.

Batlle JF, Fantes F, Riss I, et al. Three-year follow-up of a novel aqueous humor microshunt. J Glaucoma. 2016;25(2):e58–65.CrossRefPubMed

34.

Nagar M, Ogunyomade A, O’Brart DPS, Howes F, Marshall J. A randomised, prospective study comparing selective laser trabeculoplasty with latanoprost for the control of intraocular pressure in ocular hypertension and open angle glaucoma. Br J Ophthalmol. 2005;89(11):1413–7.CrossRefPubMedPubMedCentral

35.

Iordanous Y, Kent JS, Hutnik CML, Malvankar-Mehta MS. Projected cost comparison of trabectome, iStent, and endoscopic cyclophotocoagulation versus glaucoma medication in the Ontario Health Insurance Plan. J Glaucoma. 2014;23(2):e112–8.CrossRefPubMed

Title: The New Era of Glaucoma Micro-stent Surgery
Authors: Demetrios T. Manasses
Leon Au
Publication date: 01-12-2016
Publisher: Springer Healthcare
Published in: Ophthalmology and Therapy / Issue 2/2016
Print ISSN: 2193-8245
Electronic ISSN: 2193-6528
DOI: https://doi.org/10.1007/s40123-016-0054-6

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